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CMS Finalizes 2017 Payment and Policy Updates to Medicare Health and Drug Plans

By on April 5, 2016

SAN JUAN – The Centers for Medicare & Medicaid Services (CMS) has released the final Medicare Advantage and Part D Prescription Drug Program changes for 2017, which seek to provide stable payments to plans and make improvements to the program for plans that provide care to the most vulnerable enrollees.

Factoring in adjustments for the health of patients covered by a plan, the final number works out to about a 3 percent increase for Medicare Advantage and Part D prescription plans. CMS will also implement an interim adjustment to the star ratings to “reflect the socioeconomic and disability status of a plan’s enrollees.” Additionally, the finalized policies “will provide much needed stability to the Medicare Advantage program in Puerto Rico,” CMS’s statement reads.  

money stethoscopeIn response to the release, Resident Commissioner Pedro Pierluisi said, “I and others have been fighting hard to stabilize and strengthen the Medicare Advantage program in Puerto Rico, which provides health insurance to nearly 570,000 seniors and disabled individuals on the island, including nearly 300,000 low-income seniors who are enrolled in both Medicare and Medicaid, which is known in Puerto Rico as Mi Salud.

“Although I am still reviewing the details of the final rule, my preliminary reading indicates that we have achieved a very positive result.  According to a summary released by CMS, ‘CMS will implement a number of changes in 2017 that will significantly benefit Medicare Advantage enrollees in Puerto Rico.’  The summary further states:  ‘As a result of the finalized policies, the expected revenue change for Medicare Advantage Plans in Puerto Rico is 1.25 percent.’  According to one estimate I have received, the final rule will result in an increase in annual funding to Puerto Rico of approximately $430 million per year.  

“Notwithstanding this positive development, there is still much work that remains to be done to ensure that Puerto Rico is treated fairly under federal health programs, whether it be Medicaid, traditional Medicare or Medicare Advantage.”

Medicare also announced a transition period for some employer-sponsored plans that were facing a cut. It will be spread over two years.

“We continue to strengthen Medicare Advantage and Medicare Part D, in particular for enrollees who need additional investments in their health, such as dually Medicare-Medicaid eligible individuals and those with complex socioeconomic needs,” said Acting Administrator Andy Slavitt.


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