The insurance group, America’s Health Insurance Plans (“AHIP”) recently asked the Trump administration to postpone implementing new requirements for Medicare Advantage plans, and instead make them voluntary until 2022. AHIP noted that the proposed Centers for Medicare and Medicaid (“CMS”) rule would be difficult to implement due to the ongoing disruptions in the industry brought about by the COVID-19 pandemic.
In the letter to CMS, AHIP noted that “[e]normous uncertainties about the scope, cost, duration and ultimate impact of the COVID-19 crisis remain that could have significant and unforeseen effects on the Medicare Advantage (MA) and Part D programs in 2021.” They noted that actuarial uncertainties are affecting current 2020 operations and the ability of MA and Part D plans to prepare 2021 bids.
In their letter, AHIP also commented on various aspects of the proposed rule. They indicated their support for policies that would support the delivery of better care and better value, and that would improve value and reduce costs for Medicare participants. Some of these include flexibility in dialysis care and delivery, including plan flexibility in network adequacy standards for dialysis facilities, and flexibility to expand telehealth and rural access and address anti-competitive state laws. AHIP also noted that CMS’ proposal to expand private-sector negotiating tools in Part D will help expand competition among manufacturers.
However, AHIP disagreed with some policies in the proposed rule, indicating that they would limit choice and diminish program value. For instance, limiting certain MA plans attractive to dual eligible enrollees (i.e., individuals that are dually eligible for Medicare and Medicaid) should be avoided as it could disrupt their care. AHIP was also critical of the proposal to exclude performance outliers when setting cut points for star ratings, as doing so would adversely affect premiums and supplemental benefits. The group also expressed concerns about policy proposal to increase the weight of patient experience/ complaint surveys and access measures relative to other measures. Doing so would generate bias and significant year-over-year volatility. Finally, AHIP indicated that it is concerned with the proposal to exclude organ acquisition costs for kidney transplant from MA benchmarks.
AHIP also commented on the proposed implementation timelines, noting the late release of CMS’ rulemaking for 2021 and the uncertainty surrounding the COVID-19 crisis raises concerns about the ability to comply with June 1, 2020 deadline for submitting 2021 bids. AHIP requested that CMS either not move forward implementing the proposed rule, or, to the extent that they do move forward, make compliance with the proposed rule voluntary rather than mandatory until 2022.
AHIP concluded the letter by acknowledging CMS’ “tremendous efforts … to move the MA and Part D programs forward amidst the unprecedented challenges our nation faces due to COVID-19” and that they look forward to working with the agency to ensure “affordable and innovative” MA and Part D choices.