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New ACAP Report Shares Policy Recommendations on Medicare Advantage Coding Intensity
FOR IMMEDIATE RELEASE: October 21, 2024
FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515, jvanness@communityplans.net
NEW ACAP REPORT SHARES POLICY RECOMMENDATIONS
ON MEDICARE ADVANTAGE CODING INTENSITY
WASHINGTON—A new report from the Association for Community Affiliated Plans (ACAP) highlights the reasons why policy changes to Medicare Advantage (MA) coding intensity must reflect the diversity of plans in the Dual Eligible Special Needs Plans (D-SNP) and Medicare Advantage Prescription Drug Plans (MA-PD) space. It emphasizes that effective coding intensity policies must balance achieving policy goals for accurate MA spending with the heterogeneity inherent to the MA and D-SNP markets, and cautions that the failure to do so could bring about unintended consequences for Medicare beneficiaries.
Coding Intensity Options: The Perspective of Safety Net Health Plans offers assistance to policymakers working to achieve this balance by detailing policy recommendations and options for consideration.
The report highlights the unique and complex medical needs of individuals served by both Medicare and Medicaid and showcases how ACAP’s D-SNP member Safety Net Health Plans work to align care coordination between the programs while also addressing social determinants of health.
Key recommendations from ACAP include:
- Continue allowing D-SNPs to submit diagnostic codes obtained through HRAs and chart reviews;
- Assess model enhancements to improve the accuracy of the MA risk adjustment model and reduce reliance on annual diagnostic capture; and
- Evaluate replacing the current coding intensity adjuster with a tiered coding adjustment system.
“ACAP is dedicated to collaborating with policymakers and stakeholders to ensure the sustainability of the Medicare Advantage program and to make sure that MA plans are accurately compensated for the populations they serve,” said ACAP CEO Margaret A. Murray. “We want to be certain that any changes to coding intensity policy accurately reflect the needs of the populations served. One of the things we know about Medicare Advantage is that one-size-fits-all philosophies tend not to work well – applying such a philosophy to coding intensity could have serious consequences for dual eligibles.”
ACAP’s proposed policy solutions and considerations also encourage the identification and management of chronic conditions that account for different types of MA plans.
To read the recommendations in full, visit ACAP’s Web site.
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About ACAP:
ACAP represents 82 health plans, which collectively provide health coverage to more than 30 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly sponsored health programs. For more information, visit www.communityplans.net.