2013 Final Call Letter and Regulations
Along with the Final Rate Notice for 2013, CMS recently published the Final Call Letter and a Final Rule with Comments. These documents include changes to policy and operational guidance for Medicare Advantage (MA) and Part D plans for CY 2013.
Our summary of the Final Rate Notice and Final Call Letter
Our summary of the Final Rule with comments
While there are a lot of details in these documents, there were not very many significant policy changes. While CMS projects a weighted average county rate increase of 3.07 next year, GHG analysis suggests that after adjusting for Fee-for-Service rebasing, changes in county quartiles and the ACA phase in, that the actual county rate will vary widely and some counties could even see a net reduction. The Final Call Letter includes exceptions to the new regulatory provisions that allows MAOs to limit DME to specific manufacturers or brands and includes performance and quality criteria for Dual SNPs to offer additional supplemental benefits.
Not surprisingly, the Final Rule keeps the provision that allows CMS to terminate a plan that does not achieve at least a 3 star rating for 3 consecutive years. This is an important value-based purchasing authority that will put some teeth behind the star rating system. Fortunately the three year period starts with data collected this year and is not retrospective. Due to implementation challenges, the final rule does not require Medicare Advantage Organizations (MAOs) to apply the Fee-for-Service Hospital Acquired Infections (HAC) and Present on Admission (POA) Indicator policy for network hospitals. Capitation payments make it difficult for MA plans to reduce payment to hospitals retroactively. CMS sent another signal that it is serious about integrating care for Dual Eligibles by broadening the number of dual SNPs that can offer additional supplemental benefits. Based on the large volume of comments, CMS will not finalize the proposed changes to regulations on the conditions of participation for Long Term Care Facilities (LTC) that would require pharmacists to be independent. The comments identified the need for changes in this area, but the best solution is not the policy in the proposed regulation and CMS is encouraging more transparency in the industry.