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Webinar Details

  • Pub Code: C3A11-11WEB
  • Speakers
    • William A. MacBain
    • Tim Courtney

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CMS’s ‘45-Day Notice’ and Its Potentially Severe Impact on MA Payment Rates

March 7, 2013 Webinar - Listen On-Demand or Get a CD!

It is difficult to imagine worse news for Medicare Advantage and Part D plans than provisions included in the 2014 rate notice and “call letter” issued by CMS on Feb. 15. Not only were there negative surprises in the base payment rates themselves, but there also was a host of likely methodology changes that could cut the payments received by MA sponsors in some cases starting in 2014 and in others beginning in 2015. They include significant alterations in how risk adjustments are determined, how CMS calculates the key fee-for-service cost in each county and how much plans may increase a beneficiary’s total cost from 2013 to 2014. Find out what this key “45-day notice” document means now for Medicare Advantage and Part D organizations and their partners…and steps you can take to cushion the blow.

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The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.

Sponsored by Atlantic Information Services, Inc., publisher of Medicare Advantage News, AIS’s Health Reform Week and Health Plan Week

The combined effect of the changes proposed for Medicare Advantage (MA) and Part D plans in the “45-day notice” issued Feb. 15 amounts to the biggest collection of bad news the industry ever has received at one time. First, plans and their advisers alike were surprised with what amounts to a several-percentage-point cut in their base payment rates for 2014. Then, CMS proposed changes in the ways plans have managed to offset some of the effects of rate cuts in the past. These potential changes include altering the risk-adjustment model in a way the agency itself says will lower risk scores and limiting how plans can use health risk assessments to boost risk scores.

The financial outlook is even bleaker when you combine these new proposals with the large coding intensity adjuster increase plans will have to absorb for 2014 plus a reduction in the amount by which plans can boost beneficiaries’ out-of-pocket costs for next year. There also are tremendous uncertainties that plans may face from another “rebasing” of counties to determine which payment quartile they’re assigned to, and from a change CMS is considering in how it calculates the costs on which county rates are based.

Hear two experts in the strategic analysis of Medicare Advantage payment rates dissect the new proposals and assess the implications of the 45-day notice for MA plans and their partners. You’ll get reliable strategic information and answers to key questions such as:

  • Why did the MA payment rates in the 45-day notice come out so much different — and worse — than experts had expected?
  • How likely is CMS to make changes in the final notice, based on comments it requested, to reduce what the agency itself recognized would be the significant adverse effect on plans?
  • What do the potential risk-adjustment changes CMS outlined in the preliminary notice mean for MA payment rates in the future?
  • How would health plan strategies be affected by the change CMS is considering to limit the use of health risk assessments in improving MA plans’ risk scores?
  • What is the likely effect on plans of the changes CMS is making and considering to both rebase counties again and alter the system by which fee-for-service costs in a county are calculated?
  • In preparing their bids for 2014, how can insurers take into account the other new perils for MA plans, such as the potential hits from sequestration and the start in 2014 of the health reform law’s fee on insurers?
  • How should you figure in your planning the potential impact of a short- and/or long-term “doc fix” via a change in the Sustainable Growth Rate methodology?
  • How will the financial outlook for MA plans be impacted by the rules on how minimum MA medical loss ratios in 2014 and beyond will be determined, which were issued at the same time as the 45-day notice?

Speakers

WILLIAM A. MACBAIN is senior vice president, finance of Gorman Health Group, LLC. He has more than 25 years of experience in senior management positions in the health care industry, including serving as chief financial officer of Capital District Physicians’ Health Plan in Albany, N.Y., and senior vice president and chief operating officer of Geisinger Health Plan in Danville, Pa. Mr. MacBain has been a board member of the American Association of Health Plans (the predecessor to AHIP), a member of the Medicare Payment Advisory Commission and president of the Managed Care Association of Pennsylvania.

TIM COURTNEY is senior consulting actuary at Wakely Consulting Group, Inc. in Clearwater, Fla. Mr. Courtney joined the firm in 2010 after serving as a managing director at Ingenix Consulting and an associate actuary at Milliman. He has been a health actuary for more than 20 years and has broad experience in projecting financial data for MA and Part D plans, including development of their bids. Recently, he had an article published in the Health Watch publication of the Society of Actuaries, of which he is a fellow, on the future of MA revenue.

Moderator: Jim Gutman, managing editor Medicare Advantage News and AIS’s Health Reform Week

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CMS’s ‘45-Day Notice’ and Its Potentially Severe Impact on MA Payment Rates

Place your order through our secure shopping cart

$329.00
$329.00

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