CHA News Article

Changes Proposed to Risk Adjustment for Medicare Advantage Capitation Rates

The Centers for Medicare & Medicaid Services (CMS) has issued part one of its annual advance notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies in late December. The advance notice is being issued in two parts this year due to requirements of the 21st Century Cures Act, which mandated certain changes to the Part C risk adjustment model and a 60-day comment period for the changes.

For 2019, CMS proposes to include additional mental health, substance use disorder and chronic kidney disease conditions in the risk adjustment model for payment. The new risk adjustment model would be phased in using a blend of 25 percent of the proposed new risk adjustment model and 75 percent of the current risk adjustment model beginning in 2019. Comments on the advance notice are due by March 2.