(PRWEB) February 26, 2013
The 2014 rate notice and “call letter” the Centers for Medicare and Medicaid Services issued earlier this month contained negative surprises for Medicare Advantage and Part D plans. Learn what these proposed changes could mean for business strategies and planning in “CMS’s ‘45-Day Notice’ and Its Potentially Severe Impact on MA Payment Rates,” an upcoming March 7 webinar sponsored by Atlantic Information Services, Inc.
The combined effect of the changes proposed for Medicare Advantage (MA) and Part D plans in the “45-day notice” issued February 15 amounts to the biggest collection of bad news the industry ever has received at one time. First, plans and their advisers alike were surprised with what amounts to a several-percentage-point cut in their base payment rates for 2014. Then, CMS proposed changes in the ways plans have managed to offset some of the effects of rate cuts in the past. These potential changes include altering the risk-adjustment model in a way the agency itself says will lower risk scores and limiting how plans can use health risk assessments to boost risk scores.
The financial outlook is even bleaker when these new proposals are combined with the large coding intensity adjuster increase plans will have to absorb for 2014, plus a reduction in the amount by which plans can boost beneficiaries’ out-of-pocket costs for next year. There also are tremendous uncertainties that plans may face from another “rebasing” of counties to determine which payment quartile they’re assigned to, and from a change CMS is considering in how it calculates the costs on which county rates are based.
On March 7, in a 60-minute presentation followed by 30 minutes of responses to individual questions, William MacBain, senior vice president of finance at Gorman Health Group, LLC, and Tim Courtney, senior consulting actuary at Wakely Consulting Group, Inc., will offer reliable strategic information and answers to key questions such as:
- Why did the MA payment rates in the 45-day notice come out so much different — and worse — than experts had expected?
- How likely is CMS to make changes in the final notice, based on comments it requested, to reduce what the agency itself recognized would be the significant adverse effect on plans?
- What do the potential risk-adjustment changes CMS outlined in the preliminary notice mean for MA payment rates in the future?
- How would health plan strategies be affected by the change CMS is considering to limit the use of health risk assessments in improving MA plans’ risk scores?
- What is the likely effect on plans of the changes CMS is making and considering to both rebase counties again and alter the system by which fee-for-service costs in a county are calculated?
- In preparing their bids for 2014, how can insurers take into account the other new perils for MA plans, such as the potential hits from sequestration and the start in 2014 of the health reform law’s fee on insurers?
- How should plans figure in the potential impact of a short- and/or long-term “doc fix” via a change in the Sustainable Growth Rate methodology in their planning?
- How will the financial outlook for MA plans be impacted by the rules on how minimum MA medical loss ratios in 2014 and beyond will be determined, which were issued at the same time as the 45-day notice?
Visit http://aishealth.com/marketplace/c3a11_030713 for more details and registration information.
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://www.AISHealth.com.