CMS proposes Medicare Advantage payment and policy updates for 2015

AHA News

The Centers for Medicare & Medicaid Services (CMS) recently issued its advance notice of proposed changes to Medicare Advantage (MA) rates and payment polices for 2015. The notice includes the preliminary estimates of the national per capita MA growth percentage and Medicare fee-for-service growth percentage, which are key factors in determining the MA capitation rates; and changes in methodologies governing payment for health plan and prescription drug benefits in 2015, among other adjustment factors.

The Affordable Care Act (ACA) established a new methodology for calculating each MA county rate as a percentage of Medicare fee-for-service (FFS) spending in each respective county, and a transitional period during which each county rate is calculated as a blend of the pre-ACA rate and new FFS-based ACA rate.

For 2015, most counties will be fully transitioned to the new rate methodology, while others will continue to be based on a blended rate. Overall, MA rates would be reduced as a result, but the actual rates for specific plans would vary substantially.

Other changes to the proposed requirements for MA plans (known as the Call Letter), include a variety of changes requiring that enrollees and providers receive greater notice regarding changes to provider networks and that continuity of care for enrollees be assured. CMS said it intends to consider rulemaking that would broaden its authority to limit such changes to certain times during the year.

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CMS posts additional guidance on two-midnight policy, audits

The Centers for Medicare & Medicaid Services (CMS) Feb. 24 posted additional guidance regarding its two-midnight policy and related Probe & Educate audits.

Specifically, CMS said it will require Medicare Administrative Contractors to re-review all claims denied to date under the Probe & Educate process to ensure that the decisions and subsequent education were consistent with the agency’s clarifications on Jan. 30. In addition, CMS released preliminary data related to the Probe & Educate audit process, including examples of common claim denials during the process.

The agency also has updated its website to include instructions for how the two-midnight policy will apply to hospital transfers and off-campus emergency departments. For more, click on:

Medicaid DSH allotments to states for FY 2014 announced

The Centers for Medicare & Medicaid Services (CMS) Feb. 27 announced the preliminary federal allotments to states for Medicaid Disproportionate Share (DSH) hospitals in fiscal year (FY) 2014. The funding does not contain the DSH reductions for 2014 under the Affordable Care Act, which were eliminated by the Bipartisan Budget Act of 2013, as advocated by the AHA.

The legislation also delayed the FY 2015 DSH reductions until FY 2016 while extending the DSH cuts by one year, to FY 2023.

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Tavenner reaffirms Oct. 1 deadline for ICD-10 compliance

There will be no change in the Oct. 1 deadline for hospitals and other entities covered by the Health Insurance Portability and Accountability Act to transition to the ICD-10 coding system for medical diagnoses and inpatient procedures, Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner said Feb. 27 at the annual Health Information and Management Systems Society (HIMSS) conference in Orlando, Fla.

Topic: Advocacy and Public Policy

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