CMS Proposes Risk Adjustment Changes for MA Part C Plans / by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development

Last week, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning calendar year 2019 over the course of four years. For 2019, the agency proposes adding mental health, substance use disorder and chronic kidney disease conditions to the risk adjustment model and taking into account the number of conditions that a beneficiary has under the payment model. The advance notice also discusses an alternative risk adjustment model that would take into account all conditions that a beneficiary has, including those outside the payment model. CMS is accepting comments on the advance notice through March 2nd and expects to propose changes to other MA payment methodologies for 2019 in a separate advance notice.