Regulations, Duals and Stars

GHG recently posted our summary of the October 3 proposed rule on changes to the MA and Part D programs for FY 2013.  Most of the provisions in this rule are codifying current policies or implementing ACA provisions without interpretation.  However there are two provisions of special interest.  The first is a proposal to allow fully integrated dual eligible SNPs (FIDE) to offer supplemental benefits that are targeted to the needs of their enrollees  such as personal care services, custodial care or in-home meal delivery.  This is an exciting opportunity for dual SNPs to provide even more meaningful integration of Medicare and Medicaid services and is consistent with the movement in CMS, Congress and the health policy community to find better solutions to providing more coordinated care for dual eligibles.  AHIP has joined the bandwagon and recently released its proposal  to “Achieve Medicare/Medicaid Integration for Dually Eligible Beneficiaries” through managed care solutions.

The other regulatory provision of interest is proposed authority for CMS to terminate or non-renew MA and Part D plans that do not achieve at least an overall 3 star rating for 3 consecutive years, beginning with contract year 2013 ratings.  This would be a discretionary authority and low performing plans would not automatically be terminated from the program. CMS just released the 2012 plan ratings.   The good news is that 9 MA plans received 5 star ratings for 2012 and overall plan ratings increased to 3.44 from 3.18.  However there are almost 70 MA plans and almost 150 Part D plans that had overall scores under 3 stars for 2012.