Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

House Bill Retains Low-Quality Medicare Advantage Plans until 2027

Exemptions for low-quality Medicare Advantage plans are part of the House’s ambitious new government spending bill.

Medicare Advantage quality exemptions in new House bill

Source: Thinkstock

By Thomas Beaton

Update on 2/12/2018: Presdient Trump signed the spending bill into effect on Feburary 9th, 2018 which funds the government for two years and extends quality deadlines for Medicare Advantage plans. 

The latest government spending bill to make it through the House of Representatives includes several provisions related to Medicare Advantage (MA), including the retention of low-quality Medicare Advantage plans until 2027.

If the bill becomes law, the federal government would effectively extend MA quality compliance until 2027, which would give low-quality MA plans just under a decade to meet adequate performance benchmarks. Currently, the deadline for improving quality is set for 2018.

The House voted 245-182 to pass the bill, which primarily focuses on stopgap funding for government programs. The bill is expected to be met with political friction in the Senate, according to major news outlets including the New York Times.

The bill also adds funding for the MA Value-Based Insurance Design (VBID) Model.

The bill would allow HHS Secretary Alex Azar to test the MA VBID no later than the year 2020 and provides funding for VBID testing. MA VBID testing would additionally be protected until the start of 2022.

MA plans would be able to add potentially cost-saving benefits like telehealth and supplemental health benefits into their offerings.

MA plans could provide additional telehealth benefits for their members for plan year 2020 under the proposed bill. Plans could also provide supplemental health benefits to beneficiaries with chronic conditions for plan year 2020.

The bill allows HHS to determine if a chronically-ill member “has one or more comorbid and medically complex chronic conditions that is life threatening, significantly limits the overall health or function of the enrollee and has a high risk of hospitalization or other adverse health outcomes, and requires intensive care coordination.”

Legislators also penned a request for a GAO report to study the effects of supplemental benefits on the number of health plan bids submitted by MA organizations, the number of members eligible for supplemental benefits, and how much MA costs and premiums cover supplemental benefits.

The new MA-focused provisions in the bill support CMS initiatives to extend the MA VBID into fifteen new states and proposed rule changes that enhance MA health plan flexibilities including the additional of supplemental benefits


Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...