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).

© 2024 MMIT
Angela Maas

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. She also has written for Spotlight on Market Access since its 2017 launch. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at Hem Aware (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.

Related Posts

scientist-in-lab
July 11

Report Reveals Plan Sponsor Uncertainty Around CGTs’ Impact

READ MORE
patients-with-doctor
July 11

Collaborative Launches Employer Guide for Oncology Management

READ MORE
ftc-building
July 11

Shot and Chaser: FTC Issues PBM Report, Reportedly Plans Lawsuit

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today