The most interesting thing about the preliminary rate notice for 2017 Medicare Advantage plans may be what federal policymakers left out. The thick document made no mention of health-risk assessments, which surprised the industry. The Obama administration and the Medicare Payment Advisory Commission have targeted the assessments for reform because they suspect plans use them to game the program's risk scores and get paid more.
“It was the biggest shocker in this announcement,” said John Gorman, founder of health insurance consultancy Gorman Health Group and a former CMS official. “If (a change) was ever going to happen, it would be in the last year of the administration, when scores get settled.”
Although the CMS kept home visits untouched for another year, it may look to Congress to change them and the related payment formula that has been tied to fraudulent overbilling. There's no guarantee Congress will tackle the issue in an election year, but legislators have studied the options. Medicare insurers could score bigger payments, depending on what's enacted.
“CMS may have concluded that it lacks discretion to make such significant changes to the risk-adjustment model,” said Richard Lieberman, chief data scientist at Mile High Healthcare Analytics.