compliance

I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024.   Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, new regulatory burdens (such as the new prior authorization restrictions), and the greater costs MA plans will bear due to the Inflation Reduction Act’s (IRA) Part D changes. See my earlier blogs on this Part D topic here: https://www.healthcarelabyrinth.com/will-democrats-be-victim-of-an-october-surprise-of-their-own-making/ and https://www.healthcarelabyrinth.com/part-d-premium-woes-due-to-the-inflation-reduction-act/ . While we are outside of the two regular annual enrollment windows, increases in MA enrollment still occur given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes

Medicare Advantage (MA) plans are going to want to take note of two recent HPMS memos from the Centers for Medicare and Medicaid Services (CMS). Each touches on major areas of controversy for the program. Supplemental Benefits User Group CMS will host a user group to provide an overview of supplemental benefits data submission for encounter data records on September 26, 2024, 2:00 p.m. – 3:00 p.m. ET. You need to register in advance. See the flyer distributed with the September 10 HPMS memo on the topic. The issue of supplemental benefits is an explosive one right now. Opponents of MA say that MA plans are submitting bids that misrepresent supplemental benefit utilization and thereby inflating their margins. CMS has little to go by because encounter data for supplemental benefits is rarely submitted. CMS did two things to attack the controversial issue. First, it issued a memo requiring plans to submit