On April 7, 2014, CMS issued the 2015 rate announcement and final call letter for the Medicare Advantage and Part D programs. Notably, CMS reversed planned rate cuts to Medicare Advantage plans, and is instead replacing those cuts with payment increases.  Specifically, CMS estimates that payments to Medicare Advantage plans will increase by .04 percent in 2015, instead of being cut by 1.9 percent as originally proposed. Individual plan payments will vary by plan. 

CMS also finalized the permissible increase in total beneficiary cost-sharing to $32 per member per month for the 2015 contract year. In addition, starting in 2015, Medicare Advantage plans must notify CMS when they are considering potentially “significant” changes in their provider networks. CMS will then consult with the Medicare Advantage plans to determine whether additional actions are required to ensure that the network will continue to meet applicable Medicare standards.

CMS did not finalize the following proposed policies: (1) implementation of certain proposed changes to the plan Star Ratings system; (2) a proposal to require greater coverage in the gap between generic and brand drugs in Enhanced Alternative plans; and (3) exclusion of diagnoses from enrollee risk assessments.

To view the press release, click here. To read the full announcement, click here.

Reporter, Lauren E. Slive, Atlanta, + 1 404 572 3592, lslive@kslaw.com.