CMS finalizes MA, Part D payment and policy for 2018

The Centers for Medicare & Medicaid Services this afternoon announced changes to the Medicare Advantage and Part D prescription drug programs for calendar year 2018, which would increase payment rates by a net 0.45%. When combined with expected growth in plan risk scores, CMS expects the MA plans and Part D sponsors will see an average revenue increase of 2.95%. Other policies were largely finalized as proposed; however, as urged by the AHA, CMS will now reduce the proportion of the risk adjustment scores based on encounter data – from 25% to 15%. Previously, CMS had intended to increase the use of encounter data. In addition to finalizing the payment and policy rules for 2018, CMS is also soliciting stakeholder input on opportunities for regulatory, sub-regulatory, policy, practice and procedural changes to the MA and Part D programs to facilitate plan innovation and affordability, among other goals. Comments are due by April 24.