CMS to revise fines on Medicare Advantage plans

CMS is proposing an update to how it calculates fines imposed on Medicare Advantage plans with systemic issues that may harm beneficiaries, the agency said March 15.

CMS is soliciting comments on how it could change the calculation methodology for the 2019 contract year, and is considering its methodology for years afterward. The agency seeks comments on adjusting the formula for the fines, the frequency of adjustments, how adjustments are announced and how the calculation methodology is memorialized.

CMS is also proposing adding an aggravating factor for when Medicare Advantage plans inappropriately deny a Part C medical service or a Part D prescription and enrollees don't receive their care or medication. "Enrollees who never receive their services or medications are at a much greater risk for adverse harm compared to enrollees whose access was delayed," CMS said in its proposal.

Still, any changes to the methodology and increases in fines would be limited, as civil money penalties are capped for Medicare Advantage plans by enrollment.

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