CMS, or Centers for Medicare & Medicaid Services, recently revealed that Medicare Advantage (MA) plans will see a significant pay boost of 3.3% in 2024. This equates to a massive $13.8 billion increase compared to this year. The announcement comes from the Department of Health and Human Services and will impact healthcare providers and patients positively.

According to HHS Secretary Xavier Becerra, this increase strengthens Medicare for Americans with disabilities and senior citizens. “We are committed to ensuring private companies are holding up their end of the deal to provide quality care to beneficiaries and that payments to these companies are accurate. Together with President Biden’s budget, this update protects Medicare for beneficiaries today and beyond 2050,” he added [1].

Following the controversial advance notice released two months prior, much speculation has been about a potential 2.27% reduction in baseline payments. However, CMS has since clarified that the proposed rates will result in a net increase of 1.03% due to a 3.3% boost in the risk score for the plans.

CMS confirms that the announced rate finalizes updates to payment growth rates for MA and payment methodologies for both MA and Part D. The announcement also highlighted technical and clinical adjustments to the MA risk adjustment model to increase accuracy and ensure currency. During the press conference, CMS leaders noted that the revised risk adjustment model addresses conditions that feature significant coding variability.

According to the Deputy Administrator and Director of the Center for Medicare, Meena Seshamani, MD, PhD, the new model has been designed to accurately portray care expenses related to differing health conditions. Dr. Seshamani further elaborated that many codes for depression and diabetes were eliminated for their duplication and lack of reflection towards cost.

According to Brooks-LaSure, the MA risk adjustment model will undergo a three-year phase-in, providing stakeholders sufficient time to adapt. The new model has been introduced for two primary purposes: to address the healthcare needs of those opting for MA and to ensure CMS is performing its duties as a responsible steward of the Medicare program.

Along with implementing the “final payment rule,” CMS is also taking crucial measures to reinforce the Medicare program by establishing accountability for participating Medicare Advantage Organizations. Its plan includes recovering any undue payments this year and returning the funds to the Medicare Trust Fund, promoting the stability of the program’s financial progress.

References:

[1] “Private Medicare Plans to See $13.8 Billion Pay Hike in 2024” news.bloomberglaw.com