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Diane Publishing Books
Medicare Advantage: Changes Improved Accuracy of Risk Adjustment for Certain Beneficiaries
James C. Cosgrove (au)
The Centers for Medicare & Medicare Services (CMS) pays plans in Medicare Advantage (MA) -- the private plan alternative to Medicae fee-for-service (FFS) -- an amount per beneficiary that is adjusted to reflect beneficiary health status. This adjustment, called risk adjustment, helps ensure that health plans have the same financial incentive to enroll and care for beneficiaries regardless of their health status. In 2010, CMS announced plans to revise the major medical conditions included in its principal risk-adjustment model -- the community model -- and add a model for new enrollees in chronic condition special needs plans (C-SNP), which target beneficiaries with certain severe or disabling chronic conditions. CMS began using the C-SNP new enrollee model in 2011, in place of the general new enrollee model, to adjust MA payments for new Medicare beneficiaries who enroll in a C-SNP. This report examines the accuracy of these models for high-risk beneficiaries. Tables. This is a print on demand report.
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