CMS Proposes Updates to Part D

The Centers for Medicare and Medicaid Services (CMS) released proposed changes to the Medicare Advantage (MA) and Part D Prescription Drug Programs. CMS says that the proposal would provide fair payments to plans while rewarding high-quality care. CMS is proposing to continue to refine the star rating system to encourage improved quality. CMS proposes to modify the system to ensure that plans are not penalized unfairly for enrolling dual eligible or low-income beneficiaries.

The proposal also enhances the value of in-home assessments to support care planning and care coordination and improve enrollee health outcomes. The Advance Rate Notice proposes changes in payments. On average, the expected revenue change would be positive growth of 1.05% when combined with expected growth in plan risk scores due to coding. Plans that have shown quality improvement and have demonstrated a focus on customer satisfaction would see additional growth. Plan payment levels will continue to be somewhat higher than the equivalent payments in fee for service.

The 2016 Draft Call Letter proposes steps to ensure that plans maintain accurate provider directories and make those directories widely available, helping enrollees better understand the providers available to them. In addition, CMS proposes to work with Part D sponsors that offer limited access to preferred cost sharing pharmacies in their networks to ensure all beneficiaries have access to affordable coverage.

CMS says that enrollment and quality in the Medicare Advantage and Part D Prescription Drug program has grown since the Affordable Care Act. Medicare Advantage has reached record high enrollment each year since 2010. That trend continues in 2015 with an increase of more than 40% since passage of the Affordable Care Act. Also, premiums have fallen nearly 6% from 2010 to 2015. More than 90% of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.

According to CMS, the continued popularity of the program reflects a clear signal that Medicare Advantage and the Prescription Drug Program are attractive to health plans and beneficiaries. In 2015, CMS estimates that 60% of Medicare Advantage enrollees will be in four- or five-star plans – an increase of 43 percent since 2009.

Exchange Proposes to Offer Stand-Alone Vision Plans to Individuals

In August, California Health Benefit Exchange decided that stand-alone vision insurers could sell coverage to small businesses but not to individuals. Facing protests from VSP and a smaller Rancho Cordova eye-care insurer, Superior Vision Holdings, the agency promised last month to revisit the issue. On Friday it offered up its changes, reports the Sacramento Bee.

In a memo to the board, staffers proposed letting stand-alone companies sell eye-care coverage to adults. They also proposed letting those companies sell vision coverage to children as well, but the agency first needs clarification on a wrinkle in the new federal law.

Exchange Board Considers Allowing Stand Alone Vision Plans

The California Health Benefit Exchange Board had voted to exclude stand-alone vision plans from coverage through the California Health Benefit Exchange, at least for the first year. But the board may be reconsidering its decision, according to an article in the Sacramento Bee. Last week, the agency indicated it might back down. Without going into details, executive director Peter Lee said the board expects to revisit this matter next month. “We want to make sure we don’t foreclose any options,” he said during the monthly meeting of the agency’s governing board. VSP said in a statement that it was pleased the agency would take another look at the issue.

Stand-Alone Vision Plans Get Excluded from the Exchange

The California Health Benefit Exchange Board voted to exclude stand-alone vision plans from coverage through the California Health Benefit Exchange, at least for the first year. However, stand-alone dental plans will be allowed to compete in the exchange. Daniel L. Mannen, OD, FAAO writes in a VSP Global blog, “Since all vision care will have to be delivered by or in partnership with a health plan in the new California Exchange, the decision greatly advantages programs that are owned by health plans (Spectera, Davis Vision, and Kaiser) and means that stand-alone vision plans, like VSP, will have a harder time competing for patients. This is significant because independent optometrists may see fewer patients as people transition into the exchanges and into plans that lock them out (like Kaiser) or that pay less (like Spectera and Davis)…Access to patients is the key to optometric independence, and organizations like VSP Vision Care should be allowed to compete in the California Exchange and Exchanges across the country.”

Last Updated 01/13/2021

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