This week, our In Focus section comes from HMA Principal Eric Hammelman and Senior Consultant Narda Ipakchi. Today, Medicare beneficiaries with End-Stage Renal Disease (ESRD) are only eligible to enroll in Medicare Advantage (MA) plans if they select a MA Special Needs Plan (SNP) that specifically serves individuals with ESRD or develop ESRD while already enrolled in a MA plan. In 2018, approximately 121,000 MA enrollees (0.6 percent of the MA population) had diagnoses of ESRD, accounting for approximately 20 percent of the total Medicare ESRD population.[1] The 21st Century Cures Act, which was passed in 2016, included a provision that alters the eligibility and enrollment options for Medicare beneficiaries with ESRD. Starting in 2021, Medicare beneficiaries with ESRD will be able to enroll in any MA plan in their area. The Centers for Medicare & Medicaid Services (CMS) estimates MA enrollment of individuals with ESRD will nearly double to 242,000 in 2024, or approximately 41 percent of the total Medicare ESRD population.[2]
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POTUS FY 2021 Budget: Summary of Medicare provisions
This week, our In Focus section examines President Trump’s budget for fiscal year (FY) 2021. The budget includes a number of legislative and administrative proposals related to Medicare that are estimated to reduce net Medicare spending by $872 billion over the next ten years. It is important to note that the legislative proposals included in the President’s budget are non-binding and serve as recommendations to Congress where they may or may not be advanced. Under a Democratic-majority House of Representatives, many of the legislative proposals outlined in the FY 2021 budget are unlikely to advance. Administrative proposals are more likely to move forward, as the administration can implement these policies through its regulatory channels.
Webinar Replay: HMA Analysis of Medicare Advantage Advance Notice and Part C/D Proposed Rule
This webinar was held on February 18, 2020.
On February 6, the Centers for Medicare & Medicaid Services (CMS) issued Part II of the Advance Notice of Methodological Changes for Calendar Year (CY) 2021 which includes proposed updates to Medicare Advantage (MA) payment rates. In a departure from previous years, the agency did not release a separate Call Letter which typically includes Part C and Part D policy guidance and bidding instructions. Instead, the agency released a proposed rule which includes proposed policy and technical changes, most of which are scheduled to go into effect in the 2022 plan year. CMS also issued separate bidding instructions for plans as they prepare their bids for CY2021.
During this webinar, an HMA team of Medicare experts including Jonathan Blum, Eric Hammelman, Julie Faulhaber, and Narda Ipakchi presented an overview of the payment rate updates and proposed policy changes included in the Advance Notice and Proposed Rule. They provided interested stakeholders with an overview and analysis of the proposed changes as well as what these changes mean for Medicare Advantage plans’ existing strategies and opportunities.
Learning Objectives
- Understand what the expected 2021 rate increase for Medicaid Advantage plans means for continued industry growth and financial performance.
- Learn about updates to the Medicare Advantage Star Ratings system, including proposals to increase measure weights for patient experience and complaints.
- Learn about the proposed changes to network adequacy requirements and how the agency is promoting further use of telehealth among plans.
- Understand CMS’ efforts to implement requirements that expand Medicare Advantage coverage to beneficiaries with ESRD.
HMA Speakers
Jon Blum, Managing Principal, Washington, DC
Eric Hammelman, Principal, Chicago
Narda Ipakchi, Senior Consultant, Washington, DC
Julie Faulhaber, Principal, Chicago
HMA explores potential issues for individuals with end-stage renal disease enrolling in Medicare Advantage
Starting in 2021, Medicare beneficiaries with End-Stage Renal Disease (ESRD) will be able to enroll in any Medicare Advantage (MA) plan. The Anthem Public Policy Institute asked HMA to explore some of the potential issues associated with how MA plans are currently paid by the Centers for Medicare & Medicaid Services (CMS) for individuals with ESRD, and identify any possible modifications that CMS or Congress could make to more closely align payment with costs.
This white paper was prepared for Anthem Public Policy Institute by HMA Managing Principal Jon Blum, Principal Eric Hammelman, and Senior Consultant Narda Ipakchi.
Hospital Charges and Reimbursement for Medicines: Analysis of Cost-to-Charge Ratios
This report is an update to a previous report examining hospital markups for separately paid drugs. Our prior analysis examined hospital charges and reimbursement for 20 drugs and found that hospitals marked up charges for those drugs, on average, 487 percent of their acquisition cost. We also found that hospitals receive 252 percent of estimated hospital acquisition cost from commercial payers. Hospital reimbursement data was obtained from the Magellan Rx Management Medical Pharmacy Trend Report™: 2016 Seventh Edition (the Magellan report) and charges were calculated from Medicare claims data. For more information, please refer to our prior analysis.