Medicare Advantage and Part D Changes: Benefits Flexibility, Payment Rules, and Decreased Administrative Burdens

In April 2018, CMS released a final regulation and final call letter implementing significant changes to MA and Part D. Coupled with new statutory changes implemented as part of the Bipartisan Budget Act of 2018, there are significant policy shifts in the MA and Part D programs that will impact the industry both in the short term as well as over the coming years. Some changes have immediate impacts, including those that reduce administrative burdens on Medicare Advantage Organizations (MAOs) and Part D sponsors. Other changes, such as flexibility in benefit design for chronically ill enrollees and an expansion in permissible telehealth benefits, are not effective until 2020.

The new CMS policies also affect the uniform benefit, supplemental benefit, and meaningful-difference rules for all MAOs, as well as implement changes to the Quality Star Rating program. The guidance for MAOs and Part D sponsors includes changes to the Hierarchical Condition Category (HCC) risk adjustment model under which CMS adjusts payments to MAOs. Under the revised model, CMS will increase its reliance on encounter data when determining risk.

Listen as our authoritative panel examines the significant developments, providing an overview of the changes. The panel will discuss how these changes will impact healthcare payers and providers and offer guidance on what payers and their counsel must do to ensure compliance with the new regulations and guidance.

1. Reducing Burdens in the MA and Part D Programs
   1. Preclusion List
   2. FDR training and oversight
   3. Marketing and open enrollment
   4. Lengthening mandatory timeframes
   5. MLR reporting
2. Benefits Flexibility for MAOs
   1. Uniform benefits
   2. Supplemental benefits
   3. Meaningful-difference
   4. Value-based insurance design
   5. Telehealth
3. Changes in MA Payment and Quality Measurement
   1. New Star Rating regulations
   2. Changes to MA risk adjustment model
   3. Encounter data

The panel will review these and other vital questions:

• What type of compliance training requirements does an MAO or Part D sponsor need to impose on its FDRs?
• How does the new “preclusion list” work?
• What types of health conditions can MAOs identify for targeted supplemental benefits?
• Can MAOs provide supplemental benefits that affect social determinants of health?
• How has the calculation changed for the risk adjustment model? What does it mean for MAOs and Part D sponsors?
• How has CMS changed its Quality Star Ratings policies and which changes are significant?