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CMS Issues 2023 Medicare Advantage and Part D Advance Notice

For CFOs, finance & reimbursement staff, government relations staff

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The Centers for Medicare & Medicaid Services (CMS) has issued an advance notice with its proposed payment policy changes for Medicare Advantage (MA) and Part D drug programs in 2023. Comments on the advance notice are due to CMS by 2 p.m. (PT) on March 4.

CMS anticipates a 7.98% payment increase for MA plans in 2023 and proposes to apply a coding pattern adjustment of 5.9%, which is the minimum adjustment required by the statute for coding pattern differences in diagnosis coding between MA organizations and fee-for-service providers. 

CMS will continue the calendar year (CY) 2022 policy to calculate 100% of the risk score using the 2020 Part C CMS-Hierarchical Condition Categories (HCC) risk adjustment model, which was first adopted in the CY 2020 rate announcement. 

For Part D risk adjustment, CMS proposes to implement an updated version of the RxHCC risk adjustment model used to adjust direct subsidy payments for Part D benefits offered by stand-alone prescription drug plans and MA prescription drug plans. 

In the notice, CMS requests input on a potential change to the MA and Part D star ratings that would consider how well each plan advances health equity. CMS also requests comments on including a quality measure in MA and Part D star ratings that would specifically assess how often plans screen for common health-related social needs, such as food insecurity, housing insecurity, and transportation problems. 

Additionally, CMS requests input on considerations for assessing the impact of using sub-state geographic levels of rate setting for enrollees with end stage renal disease, particularly input on the impact of MA payment on care provided to rural and urban underserved populations and how such payment changes may impact health equity. 

Other areas that CMS is soliciting input on include a variety of payment updates and a new measure concept to assess whether and how MA plans are transforming care by engaging in value-based models with providers.  

Additional details are available in a CMS fact sheet.