Thursday, November 15, 2018

Medicaid, Medicare Advantage organizations in Puerto Rico ask for MA rate adjustment

By on January 17, 2018

SAN JUAN – The Medicaid & Medicare Advantage Products Association of Puerto Rico (MMAPA) and its members have joined with the government of Puerto Rico and congressional leaders to urge the federal government to “grant rate equality” to Medicare Advantage patients on the island.

MMAPA is a nonprofit composed of leading Medicaid and Medicare Advantage [MA] organizations, including First Medical, Humana, MCS, MMM, Molina and Triple-S, which along with the other members serve nearly two million residents, according to the association.

“The pressures and lack of resources in our system were exacerbated by cuts of more than 20 percent to Medicare Advantage, which started in 2012, and have directly affected more than 580,000 beneficiaries. These cuts led to the recent crisis in our system, whose underlying problem is that we invest only $3,500 per capita in healthcare annually, while operating within a federal system that averages an annual investment of $10,000 per person for healthcare services,” explained Rick Shinto, CEO of MMM and new president of MMAPA.

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Ahead of the issuance of the MA Advance Notice and Draft Call Letter for 2019, 16 congressional members, including Puerto Rico Resident Commissioner Jenniffer González, issued a letter to the Centers for Medicare & Medicaid Services (CMS), and the Puerto Rico House of Representatives adopted a resolution, seeking to redress these disparities.

In early January, Puerto Rico Gov. Ricardo Rosselló asked Health & Human Services Acting Secretary Eric Hargan and CMS Administrator Seema Verma to use the national average for MA rates, “or at least the U.S. Virgin Islands rate, as a proxy to establish the Puerto Rico MA rate,” the association said in Wednesday’s release.

“Puerto Rico is currently 39 percent lower than the MA rates in the state with the lowest rates, and 26 percent below the U.S. Virgin Islands,” MMAPA wrote. “At the national level, Medicare Advantage benchmark payments for 2017 averaged $826 per member per month. In Puerto Rico, the benchmark averaged $473, which is 43 percent below the national average. CMS bases benchmarks for Medicare Advantage on fee-for-service experience. In the States, fee-for-service Medicare has much higher participation than the Medicare Advantage programs, yet in Puerto Rico, MA enrollment represents more than 75 percent of the eligible population. Thus, basing the benchmark on the fee-for-service experience is not representative of the program’s costs on the island,” MMAPA continued.

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The Medicare funding cuts enacted by the Affordable Care Act (ACA) represent a major problem for Puerto Rico’s healthcare system, MMAPA said.

“Between 2012 and 2017, cuts to MA rates have represented $4 billion. The loss of these funds has triggered dramatic disparities in provider payments that are spurring the emigration of doctors and other healthcare professionals looking for better salary opportunities in the United States. As a result, U.S. citizens residing in Puerto Rico are losing access to both primary care physicians and specialists. In addition to lowering provider payments and access to healthcare services, these funding cuts also result in reduced benefits for beneficiaries,” reads the release.

Stressing that about 70 percent of the funding for the Puerto Rico healthcare system relies on Medicare, Medicaid and Puerto Rico government funds, MMAPA warns that “any cuts to these programs have a wide-ranging impact on the island’s health system.”

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