CMS has issued its draft 2017 Medicare Advantage (MA) and Part D Advance Notice and Draft Call Letter, which includes a variety of proposed policy changes and rate updates related to these programs. CMS estimates that the draft policies would increase MA rates by an average of 1.35% (considering coding trends the agency expects revenues to increase by 3.5%). Plans with high “star ratings” are eligible for quality bonus payments; CMS proposes to adjust star ratings for 2017 to reflect enrollees’ socioeconomic and disability status. CMS also proposes to implement a new MA risk adjustment model for 2017 intended to better account for the costs of serving Medicare-Medicaid dual eligible beneficiaries. In addition, CMS proposes to reduce the MA skilled nursing facility cost sharing limits and make other cost-sharing changes to encourage MA organizations to offer plans with lower voluntary maximum out-of-pocket limits. CMS also solicits comments on challenges associated with the use of alternative payment models in Medicare Advantage.
With regard to Part D, CMS proposes several policies to address drug utilization. For instance, CMS proposes to allow Part D plans to limit initial supplies of designated drugs to one month to reduce waste if the beneficiary discontinues therapy; an extended supply would be available for subsequent periods. CMS also would encourage plan sponsors to inform beneficiaries of mid-year formulary additions that may provide more value or better quality options. Furthermore, CMS is proposing additional steps to address opioid abuse, including requirements related to point-of-sale edits to prevent opioid overutilization and access to medication-assisted treatment. CMS also is soliciting comments on potential regulatory changes that would permit Part D plans to extend the adjudication timeframe for coverage determination requests for drugs subject to prior authorization or step therapy in certain circumstances.
CMS is accepting comments on the draft policies until March 4, 2016, and the 2017 Final Rate Announcement and Call Letter will be published on April 4, 2016.