AHIP Asks CMS to Reconsider Proposed Medicare Advantage Policy Changes

February 16, 2023 - AHIP is urging CMS to consider the potential adverse impacts of its proposed rule for Medicare Advantage policy and technical changes, specifically raising concerns about the star rating changes, new network requirements, and changes to the Part D Medication Therapy Management (MTM) program.

The organization submitted comments to CMS Administrator Chiquita Brooks-LaSure expressing its support for some proposals but stated that certain proposals would reduce funding or increase costs without benefiting Medicare Advantage beneficiaries.

AHIP expressed concerns about the changes to the star ratings program included in the proposed rule.

The agency proposed eliminating the reward factor and limiting the application of the hold harmless policy for improvement measures. According to AHIP, this would make it more difficult for Medicare Advantage plans to obtain funds needed to offer more choices, expand supplemental benefits, and keep premiums low.

The organization also said that the implementation of Inflation Reduction Act changes in Part D could negatively impact certain star ratings measures and plan performance due to factors outside plan control.

“While we appreciate CMS proposing to decrease the weight of survey measures relative to the weight of clinical outcome measures as AHIP has previously recommended, the overall impact of the Star Ratings proposals would be higher premiums and/or reduced benefits for enrollees, impacts that would disproportionately affect seniors and people with disabilities in underserved communities without increasing quality,” the comments stated.

AHIP also noted that the proposed network requirements fail to account for provider shortages. Some of the proposals include amending general access to services standards to explicitly include behavioral health services, codifying standards for appointment wait times for primary care and behavioral healthcare, and requiring Medicare Advantage plans to establish care coordination programs.

AHIP’s comments highlighted concerns that the new time and distance standards for behavioral health specialties and the appointment wait time mandates do not consider the staffing shortages practices are facing. The organization suggested the agency develop a more flexible approach to avoid placing unreasonable expectations and additional burden on providers.

The proposed changes to the Part D MTM program would be costly and disruptive, and CMS should not mandate an increase in staffing and administrative structure as Part D faces changes under the Inflation Reduction Act, AHIP said.

CMS should conduct additional analysis to assess the effectiveness of the MTM program before finalizing any changes.

AHIP supported the new marketing requirements in the proposed rule, which aim to protect Medicare Advantage and Part D beneficiaries from confusing and misleading marketing.

However, the organization noted that CMS should reconsider how proposals like mandated waiting periods for meetings with agents and brokers could inconvenience seniors and people with disabilities who face mobility challenges or other social barriers. Certain proposals may require longer implementation timelines and additional guidance, AHIP suggested.

AHIP also supported the proposed prior authorization standards that clarify the scope of permissible prior authorization and increase transparency. But the group urged CMS to retain certain flexibilities to allow Medicare Advantage plans to continue encouraging high-quality care delivery in safe and cost-effective settings.

Finally, AHIP commended CMS for the proposed provisions that promote health equity, including enhancing digital health literacy and using quality improvement activities to reduce care disparities.

Overall, the extensive proposed changes to the Medicare Advantage program will adversely impact beneficiaries and plans, the organization stated.

“Taken together, CMS in one plan year is making (or proposing to make) sweeping changes affecting critical components of the MA program without a comprehensive assessment of the combined impacts of those measures,” AHIP wrote.

“As the MA program continues to grow, we urge CMS to account for how so much uncertainty and change can undermine the ability of MA plans to continue offering innovative, affordable options to seniors and people with disabilities. We recommend that CMS seriously consider options to bring more stability to the program by limiting the number and scope of changes, extending implementation timelines, and other approaches.”