News Briefs

✦ Risk scores used to adjust Medicare Advantage plan payments were more than 3% higher than in Medicare fee for service, despite CMS establishing a 5.9% coding intensity adjustment to account for the impact of coding differences for 2019, according to the Medicare Payment Advisory Commission (MedPAC). This generated about $9 billion in “excess payments” to MA plans, MedPAC estimated during a presentation at its December meeting. Differences in diagnosis coding were discussed as the MA risk adjustment program’s “biggest flaw,” and MedPAC is considering an alternative for establishing benchmarks that would blend local area and national fee-for-service spending. One of the challenges cited with such a model is the need to protect smaller MA plans and startups, and MedPAC is still working through such considerations. Go to http://www.medpac.gov/-public-meetings.

✦ The U.S. Supreme Court on Dec. 4 agreed to weigh in on the dispute over the legality of Medicaid work requirements. The cases in question are Gresham v. Azar and Philbrick v. Azar, which respectively challenge Arkansas’ and New Hampshire’s section 1115 demonstration programs that make Medicaid eligibility contingent upon completing “community engagement activities” for a subset of beneficiaries. The two suits will be consolidated into one case — called Azar v. Gresham — and oral arguments will take place at a still-to-be-decided date early next year. The Biden administration, however, could roll back Trump administration-era guidance that paved the way for Medicaid work requirements waivers, making it unclear how such a move would interact with the Supreme Court’s ultimate decision. Visit https://bit.ly/3gsxwfd.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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