In its new rule proposing an array of policy and technical changes for the 2023 Medicare Advantage and Part D contract year, CMS devoted a large section to advancing integration of Medicare and Medicaid benefits for dually eligible individuals. Though the rule is largely in line with the goals of the SNP Alliance, whose member plans serve approximately 2.5 million Special Needs Plan (SNP) enrollees, the organization says many of the proposals will require greater collaboration between states and plans, as well as more specificity and standardization around the proposed collection of social determinants of health (SDOH) data.

The proposed rule, Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (87 Fed. Reg. 1842, Jan. 12, 2022), included the following provisions:

In addition to floating a variety of potential changes aimed at advancing health equity in the Medicare Advantage and Part D programs, CMS in its Feb. 2 release of the 2023 preliminary rate notice estimated that MA plans will see an average pay boost of 8% in 2023. And that estimate could change: CMS for 2022 originally estimated that plans would receive an average reimbursement increase of 2.8%, then bumped that estimate up to 4.08% in the final rate announcement.

To Evercore ISI, the 2023 estimate isn’t far off from the “all-in” rate increase of 7.6% in 2022, when considering average risk coding trend, which varies by company.

For our annual series of forward-looking articles, AIS Health recently featured the perspectives of multiple industry experts on what Medicare Advantage stakeholders will be focusing on in 2022. For a follow-up installment, we asked several health plan leaders to share how their respective organizations will be innovating this year to meet aging members’ needs, advance health equity and address social determinants of health (SDOH) amid the backdrop of the ongoing COVID-19 pandemic.

“The pandemic emphasized how our most daunting challenge — reaching our members in a new remote, digital-first landscape — remains our most compelling opportunity. Delivering home-based care to our nearly 10 million Medicare members and equipping them with the resources they need to age in place are central to our 2022 agenda,” says Jamie Sharp, M.D., vice president and chief medical officer of Aetna Medicare, a CVS Health company.

States are moving to better address social determinants of health (SDOH) and improve health equity in their Medicaid programs, and they’re asking MCOs to drive the change, according to an analysis of recent requests for proposals (RFPs) from advocacy group Together for Better Medicaid. The report identified RFPs from 10 states that have extensive SDOH and equity-based requirements for MCOs, from member screenings and staff training to close collaboration with community-based organizations (CBOs). Meanwhile, Medicaid enrollment has surged in all 10 states amid the COVID-19 pandemic. National Medicaid enrollment climbed 18.4% from March 2020 to December 2021, according to AIS’s Directory of Health Plans. See an overview of the most common SDOH requirements and the 10 states’ recent enrollment patterns below.

The rise of artificial intelligence (AI) and machine learning within health care — from clinical decision-making tools to population health stratification efforts — is loaded with potential, but experts warn that embedded data flaws can heighten health disparities and stanch the promise of an equitable playing field for consumers.

As AI-fueled devices and algorithms gain in popularity and practical use, regulators are increasingly taking notice. Multiple agencies, including HHS, the FDA and the Office of the National Coordinator for Health Information Technology (ONC) are quickly adopting regulatory frameworks to address health equity within big data.

As a condition of receiving enhanced federal funds during the COVID-19 public health emergency (PHE), states were required to take certain steps to ensure continuous Medicaid and CHIP coverage for most enrollees, leading to a nearly 18% jump in Medicaid enrollment. But with the latest PHE extension set to expire on Jan. 16, states will no longer receive such funds and will therefore no longer be required to maintain continuous coverage, although CMS has given them 12 months after the month in which the PHE ends to complete eligibility redeterminations. As a result, supporting states’ reverification efforts and ensuring that eligible members stay on the rolls or have a viable landing spot will be critical to Medicaid managed care organizations this year, industry experts tell AIS Health, a division of MMIT.