Recommends Improvements to Star Ratings and Quality Payments
Washington, D.C. (March 5, 2018) – The Alliance of Community Health Plans (ACHP) is pleased that CMS’ Advance Notice and Call Letter provides greater flexibility in Medicare Advantage, allowing health plans to offer expanded services such as transportation and assistive devices to better meet patient health needs. ACHP also reiterated its request that full quality payments be made to the highest-performing plans as intended by Congress.
“We appreciate CMS’ commitment to providing helpful flexibility for patients and health plans. The ability to better address health challenges in the home and outside of the medical setting means higher quality, more custom care for patients,” said ACHP President and CEO Ceci Connolly. “Highly coordinated, patient-centered care is what seniors deserve and what our provider aligned plans do best.”
Broadening the definition of supplemental benefits in Medicare Advantage provides patients with much-needed access to services outside medical care. It also allows health plans to better address external factors that impact a person’s health to better tailor care to individual needs. The added flexibility will allow plans to provide services such as non-skilled in-home support and equipment such as canes and portable wheelchair ramps.
The rule also takes important steps to address the nation’s opioid epidemic. Under the proposal, first-time opioid prescriptions will be capped at seven days and high-risk beneficiaries who are combining high-risk drugs with opioids will be flagged. ACHP is pleased that CMS plans to implement these critical changes, practices already adopted by many ACHP plans as part of appropriate prescribing strategies.
ACHP appreciates CMS’ continued commitment to quality and the star ratings but also makes recommendations for improvement. ACHP suggests CMS reduce the emphasis on year-to-year improvement and focus on sustained performance across the entire range of measures, from patient experience to clinical outcomes and compliance.
Once again, ACHP is urging the administration to make full incentive payments promised to the highest-quality plans. Thanks to a glitch in the benchmark calculation, millions of seniors in Medicare Advantage plans are losing out on additional benefits. An analysis by ACHP found that plans and beneficiaries will be shortchanged $821 million this year in benefits or reduced premiums. A bipartisan coalition of lawmakers supports making the full quality payments.
ACHP plans are some of the highest quality in the nation, topping the CMS Star Ratings year after year. ACHP members offer half of all 5-star rated Medicare Advantage (MA) plans. Overall, 34 MA contracts offered by ACHP members received 4 stars or above in 2017. ACHP plans provide care and coverage to more than 19 million Americans, including 2.5 million MA beneficiaries.
The most recent budget bill passed by Congress allows Medicare Advantage plans to include telehealth as a core benefit. ACHP looks forward to working with CMS on incorporating telehealth services for Medicare Advantage beneficiaries.
To access the full text of the ACHP comment letter, click here.
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 19 million Americans across 30 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.