We’ve got the 159-page 2018 Advance Notice and Draft Call Letter from CMS calling for a modest 0.25% payment increase to Medicare Advantage plans in 2018.
But take note: If there’s an increase in risk scores, that figure could rise to as much as 2.75%.
Currently, CMS determines risk scores based on a blend of encounter data—information on the services and items supplied to Medicare enrollees—and patient records called RAPS, for Risk Adjustment Processing System. Most consider the former more comprehensive data, but Medicare Advantage Organizations (MAOs) have voiced concerns about its completeness and accuracy.
CMS has included encounter data in the blend since 2015, accounting for 10 percent in the first year and 25 percent in 2017. According to CMS officials, the blend remains the same for 2018 to relieve concerns from MAOs.
The proposed advance notice gives MAO and Part D sponsors the opportunity to lobby for changes before they design plans for the 2018 enrollment period. Stakeholder comments are due by March 3, with the final rate announcement and call letter scheduled for April 3.