RADAR on Medicare Advantage

News Briefs: New MA and Part D Rule Is Pending at OMB | Nov. 18, 2021

The Biden administration’s first Medicare Advantage and Part D regulation is pending review at the Office of Management and Budget. The CMS final rule, titled “Policy and Technical Changes to the Medicare Advantage Program and Medicare Prescription Drug Benefit Program; MOOP and Cost Sharing Limits (CMS-4190),” was received on Nov. 10. It is not economically significant, according to the posting at RegInfo.gov.

Nutrition Makes Headway as MA Supplemental Benefit for 2022

The delivery of prepared meals, often triggered by a hospitalization, has played a steadily increasing role in Medicare Advantage plans’ efforts to manage members’ chronic conditions, but now the more nuanced area of nutrition is starting to gain traction as a supplemental benefit offering. Nutrition services vendors say offering healthy food options and education to at-risk members can result in major medical cost savings for plans.

Three Major Medicaid Insurers Report 3Q Gains Despite COVID Surge

A diversified portfolio was the name of the game late last month as publicly traded insurers discussed third-quarter 2021 earnings and braced for the return of Medicaid eligibility redeterminations, which could happen anytime after the latest public health emergency extension runs out in mid-January 2022. Despite a surge in COVID-19 costs in the quarter, Anthem, Inc., Centene Corp. and Molina Healthcare, Inc. all delivered better-than-anticipated earnings, which they attributed in part to Medicaid enrollment growth as states continue to put off eligibility reverifications.

Iowa Medicaid Director Refutes Managed Care Audit Results

As the Iowa Dept. of Human Services considers making changes to its managed Medicaid program, IA Health Link, State Auditor Rob Sand last month released a damning report that says the state’s 2016 transition to managed Medicaid led to an 891% increase in “illegally denied services or care.” The report also details how two managed care organizations violated provisions of their contracts with the Dept. of Human Services, although DHS says the report is flawed. Since 2019, only two insurers have been serving the program, but DHS is considering adding up to two more.

Industry Groups Get in Front of Potential Medicare Advantage Cuts

As progressives seek to keep some expansion of Medicare benefits in the president’s shrinking budget reconciliation package, industry-allied organizations have been building public-facing campaigns to protect Medicare Advantage from any “cuts.” Provisions to add dental and vision benefits to Medicare were removed from the latest text of the Build Back Better Act — likely giving MA plans less to worry about — while progressive lawmakers at press time were intent on getting drug pricing provisions into a final measure.

Select Insurers Enhance Grocery Allowances, Nutrition Benefits for Duals Next Year

As Medicare Advantage insurers promote an array of enhanced supplemental benefits for the 2022 plan year, grocery store allowances appear to be a staple among Dual Eligible Special Needs Plans. Here’s a sampling of what major D-SNP sponsors are marketing to eligible enrollees.

News Briefs

✦ CMS on Nov. 2 finalized changes intended to boost participation in the Medicare Diabetes Prevention Program (MDPP) expanded model. In the Calendar Year 2022 Physician Fee Schedule final rule, CMS finalized proposals to waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency, shorten the program services period to one year by eliminating the second year of maintenance sessions, and redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments.

Beneath High Ratings, MA-PD Stars Scores Show Shortcomings

Thanks to numerous flexibilities granted to plan sponsors during the COVID-19 public health emergency, nearly 70% of Medicare Advantage Prescription Drug (MA-PD) plans earned an overall rating of 4 stars or higher for 2022, CMS said on Oct. 8. That’s compared with just 49% of MA-PD plans in 2021. But the underlying data shows that quality improvements weren’t as impressive as the 2022 star ratings suggest, and with rising quality bonus payments (QBPs), the 2022 ratings could have major implications for MA revenue in the future, industry experts warn.

Last-Minute Memo Roils MAOs’ Third-Party Marketing Plans

Just eight days into the marketing period for the 2022 Medicare plan year, CMS issued a memo on third-party marketing that, while expected, has led to some confusion among Medicare Advantage plans and their industry partners regarding already finalized marketing materials.

Plans Seek Ways to Promote Provider Use of Z Codes

As Medicare and Medicaid plans seek ways to improve overall care quality by addressing members’ social determinants of health, an emerging source of beneficiary-level SDOH data is a subset of ICD-10 “Z Codes,” which can be attached to claims and encounters to identify causes other than a disease or injury. While there is payer enthusiasm for using these codes, new research suggests that plans have a long way to go to increase provider uptake and establish best practices in this area.