Medicare Advantage

Medicare Advantage Permitted to Address Non-medical Needs

Starting in 2020, Medicare Advantage plans will be permitted to provide non-medical benefits to their chronically ill members. As described in the Centers for Medicare & Medicaid Services’ “final call letter’ for 2020, MA [Medicare Advantage] plans are not prohibited from offering an item or service that can be expected to improve or maintain the health or overall function of an enrollee only while the enrollee is using it. In other words, the statute does not require that the maintenance or improvement expected from an SSBCI [special supplemental benefits for the chronically ill] result in a permanent change in an [...]

iqtsupport2019-04-16T06:00:54-04:00April 16, 2019|Medicare|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s April agenda were: Expanding the use of value-based payment in Medicare Medicare Shared Savings Program performance Redesigning the Medicare Advantage quality bonus program Increasing the accuracy and completeness of Medicare Advantage encounter data Evaluating patient functional assessment data reported by post-acute-care providers Options for slowing the growth of Medicare fee-for-service spending for emergency department services Options to increase the affordability of specialty drugs and biologics in Medicare Part D Improving payment for low-volume and isolated outpatient dialysis [...]

iqtsupport2019-04-09T06:00:04-04:00April 9, 2019|Alternative payment models, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Medicare Advantage Networks Not Narrowing

The primary care networks offered by Medicare Advantage plans are broadening and not narrowing, as some people have long feared. According to a study published in the journal Health Affairs, only 1.8 percent of Medicare Advantage plans offer narrow primary care provider networks, down from 2.7 percent in 2011. Meanwhile, the proportion of plans offering broad networks has grown from 80.1 percent in 2011 to 82.5 percent in 2015. In 2015, broad network plans enrolled 63.9 percent of Medicare Advantage participants, up from 54.1 percent in 2011. This is considered important because the proportion of Medicare beneficiaries enrolled in Medicare [...]

iqtsupport2019-04-04T13:00:55-04:00April 4, 2019|Medicare|

Medicare Advantage to Address Social Determinants of Health

Beginning next year, the Centers for Medicare & Medicaid Services will authorize Medicare Advantage plans to pay for some health-related but non-medical benefits for their members – benefits that will help address social determinants of health that affect the health status of many Medicare beneficiaries. As explained by Health and Human Services Secretary Alex Azar at a recent event in Salt Lake City, These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too. If seniors do end up going to [...]

iqtsupport2018-11-19T06:00:47-05:00November 19, 2018|Medicare|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s November agenda were: MedPAC’s mandated report on long-term care hospitals patient functional assessment data used in Medicare payment and quality measurement modifying advanced alternative payment model (A-APM) payments modifying the Medicare-dependent hospital program promoting greater Medicare-Medicaid integration in dual-eligible special-needs plans the Medicare Advantage quality bonus program Medicare Advantage encounter data MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the [...]

iqtsupport2018-11-06T06:00:50-05:00November 6, 2018|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

CMS Proposes Increasing Use of Telehealth by Medicare Advantage Plans

Medicare Advantage plans would be authorized to make greater use of telehealth services under a new regulation to be proposed by the Centers for Medicare & Medicaid Services. The proposal, part of a broader regulation addressing a variety of Medicare programs, would authorize wider use of telehealth services in caring for Medicare Advantage enrollees while improving provider payments for those services. According to a CMS fact sheet about the proposed regulation, The Bipartisan Budget Act of 2018 allows MA plans to offer “additional telehealth benefits” not otherwise available in Original Medicare to enrollees starting in plan year 2020. Under this [...]

iqtsupport2018-10-31T06:00:06-04:00October 31, 2018|Medicare, Medicare regulations, Medicare reimbursement policy|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week. Among the issues on the agenda of the independent agency that advises Congress on Medicare payment issues were: payment adequacy for physicians and other health professional services An alternative to the merit-based incentive payment system (MIPS) payment adequacy for hospital inpatient and outpatient services payment adequacy for ambulatory surgical center services payment adequacy and improving the equity of payments for skilled nursing facility services payment adequacy for inpatient rehabilitation services payment adequacy for long-term-care hospital services payment adequacy for home health services payment adequacy for outpatient dialysis services payment [...]

iqtsupport2017-12-13T06:00:25-05:00December 13, 2017|hospitals, Medicare, MedPAC|