December 28, 2018
Centers for Medicare and Medicaid Services
Department of Health and Human Services
P.O. Box 8013
Baltimore, MD 21244
Submitted via electronic submission system
Re: CMS-4185-P; Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-for-Service, and Medicaid Managed Care Programs for Years 2020 and 2021.
The Association for Community Affiliated Plans (ACAP) greatly appreciates the opportunity to provide comments to the Centers for Medicare & Medicaid Services (CMS) on the Policy and Technical Changes to the Medicare Advantage program for 2020 and 2021. ACAP is an association of 61 not-for-profit, community-based Safety Net Health Plans located in 29 states. Our member plans provide coverage to over twenty million individuals enrolled in Medicaid, Children’s Health Insurance Program (CHIP) and Medicare Advantage Dual-Eligible SNPs. Nationally, ACAP plans serve approximately one-third of all Medicaid managed care enrollees. Twenty-three of our plans are D-SNPs and 14 of our plans participate in the Financial Alignment Demonstration.
We submit the following comments for CMS’ consideration.
Risk Adjustment Data Validation Audits
ACAP is deeply concerned about CMS’ proposal to use the extrapolation method for RADV audits, to apply this methodology retroactively, and to not use the FFS adjuster. We feel this methodology is flawed and that CMS has not adequately proven the accuracy of this methodology or the potential impact of this methodology on small plans. In addition, the policy rationale for these proposed RADV audit changes is unclear. CMS’ goal should be to have an accurate risk-adjustment audit system; these proposed changes do not clearly accomplish that goal.
Implementing this methodology for RADV audits will result in plans being penalized for risk-adjustment errors that they did not actually make. Moreover, this proposed methodology will have a disproportionate impact on smaller, not-for-profit D-SNPs who are less financially able to pay inaccurately high audit payments. This is particularly a concern if CMS applies this proposed methodology retroactively. We strongly believe that CMS should not implement these RADV audit changes as proposed.