MA Stakeholders Urge CMS to Adjust End-Stage Renal Disease Payment Rates in 2021
March 19
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).
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