CMS amends value-based model for Medicare Advantage for 2018

New conditions, participating states and telemedicine opportunities will be included in the second year of CMS’s Medicare Advantage (MA) Value-Based Insurance Model.

The model is aimed at testing whether better engagement with MA beneficiaries encourages them to use services in a way which both improves their health and reduces costs. It’s scheduled to run for five years beginning in January 2017.

The changes announced by CMS will affect the model beginning in January 2018. MA plans in three additional states will be eligible to test the model: Alabama, Michigan and Texas, along with the seven states eligible in 2017: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.

“These states have been selected in order to be generally representative of the national Medicare Advantage market, including urban and rural areas, areas with both high and low average Medicare expenditures, areas with high and low prevalence of Low-Income Subsidies, and areas with varying levels of penetration of and competition within Medicare Advantage,” CMS said.

Other changes for the model’s second year will include adding rheumatoid arthritis and dementia to the clinical categories, and making “adjustments” to existing categories, which are diabetes, chronic obstrutuctive pulmonary disease (COPD), congestive heart failure, patient with past stroke, hypertension, coronary artery disease, and mood disorders.

The model will also allow for telehealth consults “via real-time interactive audio and video technologies for diabetics,or tobacco cessation assistance for COPD patients.”

What plans can be apply will also change in 2018.

“CMS will generally restrict the model test to plans with a minimum enrollment in the test states of 2,000 enrollees,” the agency’s fact sheet said. “However, beginning in 2018, a MA organization participating in the model test with at least one plan with enrollment over 2,000 enrollees may have additional Plan Benefit Packages (PBPs) participate with a minimum enrollee requirement of 500 enrollees; an additional plan benefit package using this lower enrollment requirement may be from that MA organization or other organizations with the same parent organization. CMS may also grant an exception upon request.”

MA plans which wish to participate will also need at least a three-star rating from CMS.

For the model’s first year, CMS said it will announce participating MA plans in September 2016. Applications for the model’s second year will be requested in the fall of 2017.