MA Stakeholders Urge CMS to Adjust End-Stage Renal Disease Payment Rates in 2021

Responding to the two-part Advance Notice proposing rate and risk adjustment changes for Medicare Advantage plans in 2021, insurers and other stakeholders expressed concern that payment rates for serving members with end-stage renal disease (ESRD) who will newly enter the MA program will not suffice.

The 21st Century Cures Act, signed into law in 2016, lifted a ban on ESRD patients enrolling in MA plans, which currently only serve those patients when they are diagnosed during the year. Part II of the Advance Notice stated that CMS will use fee-for-service Medicare reimbursement and enrollment data for beneficiaries in dialysis status from 2014 to 2018 to develop state-based ESRD MA benchmarks for 2021 (RMA 2/20/20, p. 1).

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy (formerly called Specialty Pharmacy News) since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at HemAware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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