News Headlines Article

Payers, states at odds on CMS plan to fix dual-eligible underpayment
Modern Healthcare

Health plans and state Medicaid directors disagree on how the CMS should fix its problem of underpaying plans with high numbers of dually eligible Medicare and Medicaid beneficiaries.In October, the CMS announced it would modify its risk-adjustment model after an analysis of reimbursement data revealed that some health plans were being underpaid. To address the discrepancy, the CMS suggested separating Medicare Advantage beneficiaries into six categories that identify whether they receive full or partial dual eligibility, and whether those classifications are made because they are disabled or elderly.