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HomeMedicare Dispatch → CMS to Test Value-Based Insurance Design in Medicare Advantage

CMS to Test Value-Based Insurance Design in Medicare Advantage Print E-mail
Written by MWE.com   
Friday, 18 September 2015 16:33

On September 1, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare Advantage Value-Based Insurance Design Model (Model). Medicare Advantage (MA) Organizations operating in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee may apply to use reduced cost-sharing and/or supplemental benefits to encourage enrollees with one or more of seven targeted chronic conditions to consume higher value health care services. Specifically, CMS will allow participating MA Organizations to propose specific interventions for enrollees in one or more CMS-identified chronic disease categories that involve (i) reduced cost sharing for high value services, (ii) reduced cost sharing for high value providers, (iii) reduced cost sharing for enrollees participating in disease management or related programs or (iv) coverage of additional supplemental benefits (collectively,VBID Interventions). While CMS attempts to provide a pathway forward through the MA regulations, the Model presents certain legal risks about which MA Organizations should be aware.

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Last Updated on Friday, 02 October 2015 12:02
 


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