The Centers for Medicare and Medicaid Services recently announced that Medicare+Choice reimbursement in 2004 will, in most counties of the U.S., be larger than the two percent minimum for most beneficiaries enrolled in Medicare+Choice plans, since most beneficiaries are concentrated in the counties due to receive the minimum payment increase.
This announcement contains CMS' preliminary estimates of the national growth rate used for determining the increases in Medicare+Choice payment rates in all counties. The increases for 2004 include an adjustment for changes in the growth estimates for previous years. The final new rates for all counties will be announced on May 12th.
Provisions are also included to ensure that CMS pays
accurately for treating frail elderly enrolled in specialty plans. Specialty plans
include PACE plans and certain demonstrations that have a high proportion of frail elderly
enrollees. CMS has found that adjustment is needed to pay accurately for
community-based beneficiaries enrolled in these specialty plans. For PACE plans, the
new frailty adjuster will be based on activities of daily living such as dressing, eating
or walking. It allows CMS to base PACE organization payments on the Medicare+Choice
payment rates and also take into account the level of frailty of PACE enrollees. In
2004, only ten percent of payments will use the new risk and frailty adjusters and the
remaining 90% will be based on a plan's current payment methodology. The full
effects of risk/frailty adjustment will be phased in by 2008.