CMS Issues Proposals for Medicare Advantage Plans

Posted on Monday, February 24, 2020 12:18 PM

CMS issued a proposed rule titled: Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the ElderlyThey also released Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment PoliciesThis rule incorporates some federal laws related to MA and Medicare Part D programs that include the Bipartisan Budget Act of 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act and the 21st Century Cures Act.

Most of these rules do not have a direct impact on home health, however, beginning in 2022, “CMS is proposing to add home health services, when provided in network, to the requirement that cost sharing charged by an MA plan may not exceed cost sharing required under original Medicare for MA plans that establish a mandatory or intermediate maximum out-of-pocket ( MOOP) limit. When the MA plan establishes the lower MOOP limit, the MA plan may have cost sharing for home health services up to 20 percent of the total MA plan financial liability.

CMS sets the MOOP limits as follows:

  • The mandatory MOOP limit is set at the 95th percentile of projected Medicare FFS beneficiary out-of-pocket spending.
  • The intermediate MOOP is set at the numeric midpoint of the mandatory and lower MOOP limits.
  • The lower MOOP limit is set at the 85th percentile of projected Medicare FFS beneficiary out-of-pocket spending.”

Source: NAHC Report


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