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Repealed and replaced by section 1102 of HCERA. Requires CMS to implement reductions to MA plan reimbursement to account for increases in coding intensity patterns, with cuts ramped up beginning in 2014 and again in 2019. In years 2015-2019, the cut may be no less than the previous year plus 0.25%.
CMS has implemented this coding intensity adjustment, which was increased under
section 639 of the American Taxpayer Relief Act of 2012 (ATRA).
On May 12, House Energy & Commerce Republican leaders wrote to CMS to reiterate their ongoing concerns regarding the implications of cumulative ACA-driven and agency-led MA payment policies on the underlying viability of the MA program, and ultimately, seniors’ access to these plans – particularly for those seniors of minority and low-income backgrounds. On the latter, in conjunction with the letter submitted to CMS, Committee Republicans released data prepared by the Congressional Research Service (CRS), available here, that suggests that “[MA] enrollees are disproportionately minority or lower income seniors.”
Key updates for September 2014 include:
On Feb. 19, 2016, CMS released its estimates of the CY 2017 Medicare Advantage (MA) Advanced Notice and Draft Call Letter delineating the agency’s planned changes in the MA capitation rate and risk adjustment methodologies, as well as key policy changes under Part D. An agency press release is available here. CMS estimates that, on average, MA plans will see a +1.35 percent revenue increase relative to CY 2016 due to Advance Notice policies.
On Nov. 4, MedPAC held a discussion on coding intensity and calculating benchmarks in Medicare Advantage (MA). The Commission has long-sought to keep MA spending on par with fee-for-service (FFS) levels.
2017
On Feb. 1, CMS posted the CY2018 Advance Noticedelineating proposed methodological and payment changes for MA plans, as well as key policies under Part D.
SEC. 3203. øAPPLICATION OF CODING INTENSITY ADJUSTMENT DURING MA PAYMENT TRANSITION¿øREPEALED AND REPLACED¿. øSection 3203 (and the amendments made by such section) was repealed by section 1102(a) of HCERA.¿ øSection 1102(e) of HCERA amended section 1853(a)(1)(C)(ii) of the Social Security Act with respect to the coding intensity adjustment, shown below¿ (e) ƒSEC. 1102(E) OF HCERA≈ Coding Intensity Adjustment.— Section 1853(a)(1)(C)(ii) of such Act (42 U.S.C. 1395w– 23(a)(1)(C)(ii)) is amended— (1) in the heading, by striking ‘‘DURING PHASEOUT OF BUDGET NEUTRALITY FACTOR’’ and inserting ‘‘OF CODING ADJUSTMENT’’; (2) in the matter before subclause (I), by striking ‘‘through 2010’’ and inserting ‘‘and each subsequent year’’; and (3) in subclause (II)— (A) in the first sentence, by inserting ‘‘annually’’ before ‘‘conduct an analysis’’; (B) in the second sentence— (i) by inserting ‘‘on a timely basis’’ after ‘‘are incorporated’’; and (ii) by striking ‘‘only for 2008, 2009, and 2010’’ and inserting ‘‘for 2008 and subsequent years’’; (C) in the third sentence, by inserting ‘‘and updated as appropriate’’ before the period at the end; and (D) by adding at the end the following new subclauses: ‘‘(III) In calculating each year’s adjustment, the adjustment factor shall be for 2014, not less than the adjustment factor applied for 2010, plus 1.3 percentage points; for each of years 2015 through 2018, not less than the adjustment factor applied for the previous year, plus 0.25 percentage point; and for 2019 and each subsequent year, not less than 5.7 percent. ‘‘(IV) Such adjustment shall be applied to risk scores until the Secretary implements risk adjustment using Medicare Advantage diagnostic, cost, and use data.’’.
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