CMS’ final 2024 Medicare Advantage rate announcement outlined an expected payment increase of 3.32% for MA plans, an increase from 1.03% in the advance notice. The change was welcomed across the industry.1,2
The agency also said it will phase in risk adjustment changes over three years. These changes include the transition to the ICD-10 system and revisions related to conditions subject to higher variation in coding.
CMS will remove more than 2,000 diagnostic codes from the Hierarchical Condition Categories model, including some related to diabetes, depression and vascular conditions, a change that plans have said could hurt care for members with chronic conditions and dual-eligibles.2
The Better Medicare Alliance is reviewing the rule and remains concerned about potential consequences for patient care.3 Industry stakeholders have warned that some plans may cut benefits as a result, but that this will vary based on plan type and membership, as well as geography.2
Provider groups have spoken out against the changes as well, agreeing that they could affect care for dual-eligibles and warning that the transition time is too short.3
CMS Administrator Chiquita Brooks-LaSure said the coding removals will help the agency pay MA plans more accurately and won’t restrict care for dual-eligibles.3 She added that hundreds of codes still remain for the diagnoses with codes that were removed.
In addition to these changes, the agency said that this year, the administration will begin recovering improper payments made to MA plans and will tighten oversight of the MA managed care program by:
- cracking down on certain marketing tactics;
- addressing certain prior authorization practices;
- improving access to behavioral health care; and
- increasing focus on quality and equitable care.
As CMS phases in these changes, plans that are well prepared will be best positioned to continue providing high-quality, innovative care and succeeding in both the marketplace and in helping members live their healthiest lives.
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- HHS Updates 2024 Medicare Advantage Program and Part D Payment Policies. HHS. March 31, 2023. https://www.hhs.gov/about/news/2023/03/31/hhs-updates-2024-medicare-advantage-program-and-part-d-payment-policies.html
- Wilson, R. CMS to phase in Medicare Advantage risk adjustment changes, bumping payments by 3%. Becker’s Payer Issues. April 3, 2023. https://www.beckerspayer.com/policy-updates/cms-to-phase-in-medicare-advantage-risk-adjustment-changes-bumping-payments-by-3.html
- King, R. CMS to raise Medicare Advantage pay rates by 3.3% in 2024; phase in risk adjustment changes. Fierce Healthcare. March 31, 2023. https://www.fiercehealthcare.com/payers/cms-raise-medicare-advantage-pay-rates-33-2024-phase-risk-adjustment-changes