Statement of ACAP CEO Margaret A. Murray on Revised RADV Rule for Medicare Advantage Plans
FOR IMMEDIATE RELEASE: January 31, 2023
FOR MORE INFORMATION: Jeff Van Ness, 202-204-7515; email@example.com
STATEMENT OF ACAP CEO MARGARET A. MURRAY ON REVISED RADV RULE FOR MEDICARE ADVANTAGE PLANS
WASHINGTON—Margaret A. Murray, CEO of the Association for Community Affiliated Plans (ACAP), issued the following statement today on the release of the final Risk Adjustment Data Validation (RADV) rule for plans in Medicare Advantage.
“ACAP is committed to assuring that payments to health plans and providers alike are, above all, accurate. That said, we have repeatedly expressed to CMS deep and abiding concerns with the provisions of this rule and are disappointed that few of these concerns were addressed in its final form.
“As it stands today, we are concerned that the RADV audit sampling methodology disproportionately samples plans that tend to enroll members with higher levels of health need, such as D-SNP plans that serve beneficiaries who are eligible for both Medicare and Medicaid. CMS should revise the way it selects plans to audit so that it does not overtarget plans that serve patients with high levels of need.
“We are also concerned about how these audits will address years at the height of the pandemic–2020 and 2021—when providers were not as focused on robust documentation owing to the exigent circumstances brought on by COVID.
“Looking forward, we are hopeful that CMS will continue to adjust its RADV methodology to assure that these audits not only result in accurate payments but also are distributed equitably – and in a way that avoids penalizing health plans for choosing to serve patients with limited resources or high levels of health need. We look forward to continuing conversations.”
ACAP represents 77 health plans which collectively provide health coverage to more than 25 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.
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