Proposed MA, Part D Policy and Payment Updates Focus on Quality, Access

Newly released proposed changes to the Medicare Advantage (MA) and Part D Prescription Drug programs reflect a commitment to better care and smarter spending. The proposed payment and policy changes, which would take effect in 2016, would provide fair payments to plans, reward high-quality care, and encourage wiser spending of health care dollars to minimize disruption and “create a stable and consistent policy environment,” according to an announcement by CMS.

Health Reform Spurs Improvements

Since the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), MA and Part D have experienced growth and improvement, with MA seeing record high enrollment every year since 2010—a more than 40 percent increase since the ACA was passed—and premiums have fallen by almost 6 percent. Almost all Medicare beneficiaries (90 percent) now have access to a $0 premium MA plan. The announcement notes that the increased enrollment shows that the improvements spurred by the ACA have made the programs more attractive to health plans and beneficiaries. Thus, the proposed changes “will continue this trend.”

Proposed Changes

In its proposed changes, CMS detailed its plan to continue refining the star rating system used by enrollees to select MA plans, with the goal of encouraging improved quality. The proposal also seeks to enhance the value of in-home assessments to support care planning and coordination and improve outcomes. Changes to payment rates vary among plans depending on certain factors. However, the announcement estimates that the expected revenue change would be positive growth of 1.05 percent, with additional growth for plans showing improvement and a focus on customer satisfaction. CMS also proposed working with part D sponsors to ensure access to affordable drug coverage.

Additionally, the proposal seeks to provide enrollees with more information to aid in decision making about care and coverage. Specifically, steps are proposed for ensuring the maintenance of accurate provider directories such that enrollees can better understand what providers are available to them.