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February 7, 2019

Recent Stories

From Radar on Medicare Advantage - In keeping with the administration’s theme of reducing burden on Medicare providers and plans, CMS on Dec. 4 posted a new Program Audit Process Overview containing several notable changes that have the potential to streamline the audit process for Medicare Advantage, Part D and Medicare-Medicaid Plan (MMP) organizations. But industry experts advise plans to proceed with caution, especially as it pertains to a new policy on call logs. CMS in July informed plans that it would continue using the same audit protocols and record layouts for universes in 2019 that were used in 2017 and 2018. Read more

CMS late last month released a new report summarizing its third assessment… Read more

Providing a glimpse of the 2019 Annual Election Period (AEP), CMS this… Read more

how to structure provider reimbursement and enrollee cost sharing in order to… Read more

From the Editor

Welcome to Your Radar on Medicare Advantage Subscriber Website

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May 15, 2018
CMS Posts Guidance on Supplemental Health Benefits, Uniformity Flexibility

Medicare Advantage organizations for contract year 2019 and beyond will have two new vehicles for incorporating greater flexibility into their plan benefit designs. In order to assist plans in preparing for the June 4 bid deadline for CY 2019, CMS on April 27 released two documents via the Health Plan Management System. One contains guidance on the expansion of supplemental health care benefits and the other pertains to new MA uniformity flexibility.

January 25, 2018
Latest Round of MAO Provider Directory Reviews Turned Up 'Significant Errors'

The second round of reviews from CMS's online provider directory accuracy project are in, and it appears that despite CMS’s efforts to strengthen existing sub-regulatory guidance and share best practices from its initial review of directories, Medicare Advantage provider listings are rife with errors. Findings from the Jan. 19 "Online Provider Directory Review Report" include that plans are continuing to post listings with the same frequently identified inaccuracies and that the average MA organization inaccuracy rate by location was 48.39%, compared with 41.37% identified in last year’s report.
View all the findings in the report.

January 18, 2018
Azar Intends to Preserve MA as "Robust Alternative" to FFS Medicare

The Senate Finance Committee on Jan. 17 voted 15-12 to approve Alex Azar II as the next HHS secretary, sending his nomination to the Senate floor. During a Jan. 9 hearing to evaluate Azar, many Senate Finance Committee members pressed him about his ties to the pharmaceutical industry and the price increases of certain drugs made by Eli Lilly & Co. during his tenure as CEO of the company’s U.S. division. Azar repeatedly responded that he believes the cost of all prescription drugs in the U.S. is too high and identified drug costs as one of four “critical areas” he would focus on if confirmed, the others being insurance market affordability and price, the shift from volume-based to value-based health care and the opioid epidemic.

But Azar, who served as general counsel and deputy secretary of HHS under President George W. Bush, was also queried about his stance on Medicare, Medicaid and various aspects of those programs that he would oversee as secretary. Here are highlights from Azar’s responses that may provide further clarity for insurers and pharmacy benefit managers as they contemplate the future of government-sponsored health care under Azar:

  • On possible changes to Medicare: “I am not aware of any proposals by the administration to turn the program into a voucher program. What I want to do is really make sure that our Medicare Advantage program, which two-thirds of new enrollees are signing up for — and I played a role in helping to launch and think is a great option for our seniors as they come into [the] program — I really want to make sure we’re doing everything that we can to make sure it’s a strong, robust alternative for our seniors. That’s where my energies are; my focus is there.”
  • On the role of government in negotiating drug prices: “I think where the government doesn’t have negotiation it’s worth looking at....In Part D, we do significant negotiation through pharmacy benefit managers that get the best rates of any commercial payers. We don’t do that in Part B....Where we can do so that preserves innovation and preserves access for patients, I want to look at anything that’s going to help us with drug pricing and in Part B I think we should be looking at those approaches....For the government to negotiate [in Part D], we would have to have a single, national formulary that restricted access to all seniors for medicines....I don’t believe we want to go there in restricting patient access.”
  • On the future of the CMS Center for Medicare and Medicaid Innovation: “I believe CMMI is going to be one of the very important legs we have to drive this transformation in our health care system through Medicare. We need to ideate, to pilot, to test and then generalize.”
  • On possible cuts or changes to Medicaid: “I share the commitment to the Medicaid program. It’s a vital safety net program....For many families Medicaid is a vital link or a bridge to independence eventually or a long-term need....and if confirmed, my job will be to make that program as efficient, as effective, as responsive and as available to everybody as possible....I want to make sure that we enable flexibilities for states to run [their Medicaid] programs in ways that meet the needs of their citizens....If we end up looking at any changes on the Affordable Care Act’s Medicaid expansion, I don’t believe any proposals that the president or I would support involve cutting Medicaid or cutting the expansion but rather slowing the rate of growth over the next 10 years in the interest of sustainability....Whether it’s block granting or other’d have to figure out appropriate formulas and approaches around what’s the amount of money there. I think there is a lot that can appeal from notions of block granting because I do think it helps align incentives better where the states have the empowerment and also the accountability to manage those dollars as their own really be creative and customize the use of the program and stretch it for their citizens.”
  • On a recent OIG report estimating $1.3 billion in rebate losses due to drug misclassifications in the Medicaid Drug Rebate Program: “I was very concerned that report from the Inspector General and I certainly will work with Administrator Verma as well as with CMS to ensure that the program is improved to get at that. One of the key issues I think is to ensure that the regulations and guidance are clear so that those companies knew what their obligation is and if necessary moving to enforcement.”
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