Morning Briefing
Summaries of health policy coverage from major news organizations
Medicare Advantage Plans To Get 3.4% Pay Hike In 2019, Well Over Initial Proposal
Modern Healthcare: CMS Gives Medicare Advantage Plans A Raise
The CMS finalized a rule Monday giving Medicare Advantage plans a 3.4% pay hike in 2019. That's well above the 1.84% bump the agency initially proposed and higher that the 2.95% increase for 2018. The CMS is also moving forward with plans to increase the use of encounter data to determine risk scores for plans. As a result of the finalized rule, 75% of Medicare Advantage risk scores will be based on traditional fee-for-service data, and 25% based on encounter data. That differs from 2018, when the agency used a risk score blend of 85% fee-for-service data and 15% encounter data. (Dickson, 4/2)
Bloomberg: Medicare To Boost Private Plan Payments By 3.4% Next Year
That’ll be a boon for insurers such as UnitedHealth Group Inc. and Humana Inc. that have big businesses selling the private plans, known as Medicare Advantage. Including changes based on how sick or healthy people are, the total increase in payments to insurers is estimated to be about 6.5 percent, on average, the Centers for Medicare and Medicaid Services said in a statement Monday. (Tracer, 4/2)
Politico Pro: CMS Boosts Medicare Advantage Payments By 3.4 Percent In 2019
One area where insurers didn’t get their way: encounter data. CMS will boost the share of the payment formula that is based on encounter data — essentially paid claims records — from 15 to 25 percent. Insurers have argued the records are inaccurate and shouldn’t be relied on to determine payments. (Demko, 4/2)
Stat: Medicare Puts Off Decision On Lowering Drug Prices Patients Pay
The Centers for Medicare and Medicaid Services laid out a bevy of initiatives Monday that officials said would reduce drug prices for patients covered by the Medicare Part D prescription drug program — but they have made no decisions yet on an issue that has confounded lawmakers and patients alike. That issue is whether the discounts that pharmacy benefit managers negotiate for drugs — the “rebates” that lawmakers have been raising questions about in recent months — as well as other fees, should go toward lowering the price that a patient pays at the pharmacy. (Swetlitz, 4/2)
