The CMS, in its final notice to Medicare Advantage and prescription drug plans, said it would change little from its preliminary guidance on formulas used to determine payment rates, drawing battle lines between itself and the insurance lobby.
In a directive released Monday to the plans that participate in Medicare Advantage, the CMS said it would continue to adjust the annual growth percentage to assume a scheduled 21% physician pay cut even though Congress almost certainly wont allow that to happen. Still, under current law, the CMS said the growth percentage would be 0.81% for 2010, a slight change from the 0.5% predicted weeks earlier in its preliminary assessment.
Under that formula, Medicare Advantage plans will see reduced payments next year, said Robert Zirkelbach, spokesman for Americas Health Insurance Plans. Because they are based, in part, on scheduled cuts to physician payments that Congress will never let go into effect, these rates could impact seniors in ways Congress never intended, Zirkelbach warned.
The CMS also said it would continue to correct for differences in how Medicare Advantage plans coded certain ailments compared with those found in traditional Medicare, resulting in a reduction of 3.41% to plans risk scores. This is the first year the CMS has adjusted for different coding patterns, and agency officials warned that the reduction for 2011 will likely be even steeper.