Radar on Medicare Advantage
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Senate Democrats Push for MA Marketing Fixes, but Not All May Be Feasible
After releasing the results of their multistate probe into the marketing practices of Medicare Advantage plans and their partners, Senate Finance Committee Democrats are urging CMS to enhance its oversight of MA marketing and issue “commonsense” regulations as soon as possible. The report, Deceptive Marketing Practices Flourish in Medicare Advantage, illustrated dozens of “aggressive marketing tactics” in 14 states and advised CMS to take various measures within its regulatory reach. But industry experts tell AIS Health, a division of MMIT, that not all recommendations may be doable in the near term. And they say it’s likely CMS will see how recent efforts fare before pursuing steps such as prohibiting MA organizations from contracting with entities that purchase lists of leads.
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GOP-Controlled House Could Eye MA Overpayments, ‘Questionable’ Marketing
With a few midterm races unresolved as of mid-November, Democrats are projected to narrowly retain control of the Senate while Republicans will likely take back the House in the next Congress. That raises numerous questions about the future of health care policy, but D.C. insiders say House Republicans are likely to pursue achievable items rather than reach for the stars. Regardless of who controls each chamber, however, the experts suggested that more accountability and oversight is expected in Medicare Advantage.
“For once, repeal and replace isn’t the defining backbone of Republican health policy in Congress,” said Tarplin, Downs & Young Partner Jennifer Young, referring to multiple GOP efforts to scrap the Affordable Care Act, during a Nov. 4 webinar hosted by Kaiser Family Foundation (KFF). “It took us years, but I think we have learned that repeal and replace was not a winning issue and I think there’s been an acknowledgment that a Democratic president…isn’t likely to sign repeal and replace into law,” said Young, who served as assistant secretary for legislation at HHS and senior counselor to then-Secretary Mike Leavitt during the George W. Bush administration.
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MedPAC Mulls Concept of Standardizing Common Supplemental Benefits in MA
As Medicare Advantage insurers continue to grow their supplemental benefits offerings and CMS maintains a focus on improving the consumer experience, the Medicare Payment Advisory Commission (MedPAC) has begun work on the nascent concept of standardizing certain benefits in MA. During its Nov. 4 public meeting, the commission seemed mostly interested in standardizing a limited number of common supplemental benefits in the name of helping beneficiaries make better plan comparisons, but several commissioners expressed concern about potentially hampering MA plan innovation.
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South Dakota Could Be the Last State to Expand Medicaid for Foreseeable Future
A South Dakota ballot initiative that would finally bring Medicaid expansion to the state triumphed in the midterm elections, passing with 56% of the vote. It’s the latest in a string of successful ballot initiatives in expansion holdout states — and perhaps the last. While there have been rallying cries of support for expansion in some of the 11 remaining holdout states, the efforts of Democratic governors and organizing committees working to get expansion on future ballots have been stymied for years.
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News Briefs: CMS Extends Plans to Issue a Final Rule on Extrapolation in RADV Audits
CMS is buying itself more time to make a final determination about its use of extrapolation in Risk Adjustment Data Validation (RADV) audits. In a Federal Register notice published on Nov. 1, the agency pushed its Nov. 1 deadline to issue a final RADV rule to Feb. 1, 2023, saying it was unable to meet the already extended deadline “because of ongoing exceptional circumstances.” The Trump administration in a November 2018 proposed rule (83 Fed. Reg. 54982, Nov. 1, 2018) said its plans to recoup improper payments starting with payment year 2020 would not involve a “fee-for-service adjuster” and that it may apply this extrapolation methodology when finalizing audits dating back to payment year 2011. That rule received pushback from insurers for its potential to inflate audit recoveries, skew the MA bidding process and impact beneficiary cost-sharing and MA product offerings. The provision was not finalized by the Trump administration. CMS in October 2021 extended the statutory three-year timeline for completing the rulemaking, explaining that it received extensive public comments on the proposal and the FFS adjuster study that it released just prior to publishing the November 2018 proposed rule.
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