Staying updated with the latest CMS (Centers for Medicare & Medicaid Services) releases is crucial for ensuring compliance and accuracy in Medicare Advantage and Prescription Drug Plans. Over the past few months, CMS has introduced a range of updates through HPMS, including essential corrections to model notices, changes to the 2025 RxHCC Risk Adjustment model, and adjustments to normalization factors. These updates, which will come into effect starting in 2025, ensure that plans reflect the evolving healthcare landscape, particularly around chronic conditions and beneficiary risk scores. Let’s dive into the key highlights from recent CMS releases!
Key CMS HPMS Updates from Summer 2024: What You Need to Know
1. 2025 RxHCC Risk Adjustment Model
The CMS updated its Risk Adjustment model for 2025, focusing on accurate payment adjustments for Medicare Part D beneficiaries. The RxHCC model, based on 2021 diagnoses, brings significant changes to risk scoring, improving how payments reflect health conditions like diabetes and heart disease. MA-PD and PACE plans will see these changes starting January 2025.
2. Correction to ANOC and EOC Models
In August 2024, CMS issued corrections to several model notices for Contract Year (CY) 2025. Notable changes include:
Updates to inpatient hospital costs for Cost Plans.
Removal of telehealth service references for physical therapists, occupational therapists, and audiologists in several plan types.
Clarifications on appeals, emphasizing timelines and proper contact points for enrollees.
Adjustments to LIS Riders to eliminate unnecessary references to deductibles
3. Normalization Factors
CMS announced updates for normalizing risk scores for MA-PD and PDP beneficiaries for 2025. This ensures that payments reflect recent changes in health care utilization and costs, ensuring fairness in payments.
4. Updated Communication Tools
To better serve plans, CMS has also updated the Monthly Membership Reports (MMRs) and Model Output Reports (MORs). This ensures that plan sponsors have accurate data regarding beneficiary risk scores.
Preparing for 2025:
With these updates, Medicare Advantage and Prescription Drug Plan sponsors must adjust their systems and communications accordingly. Compliance with these new rules and timely communication to beneficiaries is essential for a smooth transition.
For detailed guidance, review the recent CMS releases through HPMS and ensure that your organization stays compliant with these evolving standards.