Washington(July 24, 2018) – The Alliance of Community Health Plans (ACHP) applauds Congress for passage of H.R.4952, the Improving Seniors Access to Quality Benefits Act. The bipartisan bill shows a commitment from Congress in prioritizing value and quality in Medicare Advantage.
“In 2018, over $821 million in quality incentive payments promised to the top Medicare Advantage performers will be lost – real money that could be reducing premiums or providing additional benefits to seniors in Medicare Advantage,” said Ceci Connolly, President and CEO of the Alliance of Community Health Plans. “This bill is critical to showing the impact of these lost benefits on our high performing health plans and millions of seniors nationwide. We thank Reps. Mike Kelly and Ron Kind for their leadership on this issue and their commitment to value in the health care system.”
Quality bonus payments in Medicare Advantage, which must be returned as benefits to enrollees, are subject to a payment cap. The glitch in how HHS has interpreted this artificially cuts off the full payments to the highest quality plans. This year, over 11 million people in Medicare Advantage will miss out on increased services and/or reduced premiums due to this payment flaw. If corrected, ACHP member plans would be able to offer additional or enhanced benefits such as dental, hearing and vision services. One ACHP member, Security Health Plan, part of the Marshfield Clinic in Wisconsin, could reduce its monthly Medicare Advantage premium by $25 per month.
H.R. 4952 directs the Department of Health and Human Services (HHS), in consultation with industry stakeholders, to study the effects of including these quality bonuses in Medicare Advantage payment caps and is an important step in ensuring value in the Medicare Advantage program.
“Securing the quality payments promised to the top Medicare Advantage performers is critically important to our members,” said Connolly. “A study is an important step forward. It’s also critically important that the quality incentive payments are removed from the benchmark cap calculation, so that Medicare Advantage can best meet the needs of consumers and patients.”
The good news is that the Secretary of HHS has the authority to remedy the payment issue immediately. There is also widespread bipartisan congressional support for the belief that the Secretary can remedy the glitch administratively. ACHP offered support for this bill earlier this year.
The Alliance of Community Health Plans (ACHP) is a national leadership organization bringing together innovative health plans and provider groups that are among America’s best at delivering affordable, high-quality coverage and care. ACHP’s member health plans provide coverage and care for more than 21 million Americans across 32 states and the District of Columbia. These organizations focus on improving the health of the communities they serve and are on the leading edge of innovations in affordability and quality of care, including primary care redesign, payment reform, accountable health care delivery and use of information technology. To learn more, go to www.achp.org and follow ACHP on Twitter @_ACHP.