2018 Advance Notice and Draft Call Policy Primer

Introduction

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Advantage 2018 Advance Notice and Draft Call Letter, which includes methodological changes for calendar year 2018 for Medicare Advantage capitation rates, payment policies, as well as other policies impacting beneficiaries, providers, and other stakeholders.

The Rate Notice is the portion of the proposal that deals with elements strictly related to payment updates and the Draft Call Letter contains proposals related to the Quality Rating System and information related to bid preparation.

This paper summarizes key elements in the 2018 Advance Notice and Draft Call Letter.

Key Takeaways

The 2018 Advance Notice and Draft Call Letter indicate a commitment to stability in Medicare Advantage. CMS proposed a modest update to payment based on updated Fee- For-Service (FFS) Medicare cost trends and shifting demographics in Medicare. CMS responded to stakeholder feedback and requested additional feedback on slowing the implementation of certain policies, including the phase-in to Encounter Data as a diagnosis source and the move to a new methodology for Employer Group Waiver Plans (EGWPs).

CMS also acknowledged that benchmark caps are an impediment to incentivizing quality. There was also discussion of improvements to the Star Rating System. However, other important issues in Medicare Advantage, such as implementation of the Medicare Diabetes Prevention Program, improving provider directory accuracy, and value-based arrangements, were not discussed.

KEY DATES

There is a 30-day official comment period and stakeholders have until 6:00 p.m. EST on March 3, 2017 to formally submit comments to CMS. The Final Notice and Call Letter will be released 60 days after the Advance Notice and Draft Call Letter, on April 3, 2017.