On Friday, February 20, 2015, CMS released its Advance Notice of Methodological Changes for Calendar Year 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter (the “Advance Notice and Call Letter”).  CMS stated that changes in payment rates would affect plans differently depending on a variety of factors, but that, on average, plans could expect a positive growth of around one percent, with plans showing quality improvement and demonstrated focus on customer satisfaction seeing additional growth.  Comments on the Advance Notice and Call Letter are due by March 6, 2015. 

With respect to proposed MA policy changes, CMS stated that the proposed policies “promise to provide enrollees with greater information to make informed decisions about their care and their coverage,” including proposed steps to ensure that plans maintain accurate provider directories and make them widely available.  CMS also proposes to work with Part D sponsors that offer limited access to preferred cost sharing pharmacies in order to ensure that all beneficiaries have access to affordable coverage.  In addition, CMS is proposing changes to the star rating system that would modify the system to ensure that plans are not unfairly penalized for enrolling dual eligible or low-income beneficiaries, and that would enhance the value of in-home assessments so that they would be used to support care planning and care coordination and improve enrollee health outcomes. 

Comments on the Advance Notice and Call Letter are due by March 6, 2015.  CMS will publish the Final Rate Announcement and Call Letter on April 6, 2015.  CMS’s press release is available by clicking here.  For a copy of the Advance Notice and Call Letter, please click here. 

Reporter, Kerrie S. Howze, Atlanta, + 1 404 572 3594, khowze@kslaw.com