CMS Rate Announcement reintroduces blending of RA models for the 2024 payment year
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On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement, revising some of the proposed changes in the 2024 CY Advanced Notice. Per CMS’s notice, payment to MA plans is projected to be on average 3.32% higher in 2024 than 2023.
The overall payments to MA organizations are determined using the risk scores computed based on the CMS’s Risk Adjustment models applied towards the payment year. After considering the comments received on the changes proposed in the 2024 Advance notice, released February 2023, CMS is implementing the new risk adjustment model in phases.
Phased progression announced for risk adjustment
CMS is advancing with the revisions to the risk adjustment model phasing in the technical updates proposed in advanced notice as “v28 model”, which includes the restructured condition categories using the International Classification of Diseases (ICD)-10 classification system, as well as revisions focused on conditions that are subject to more coding variation.
The risk adjustment model will be phased in over three years, with blending of risk models to compute the factors for payments in the first two years. The blended schedule is provided below:
CMS remarked that the new model is more accurate than the 2020 model because it factors in more recent diagnoses and costs and includes clinically meaningful conditions that predict costs developed from experience with ICD-10 and with clinician input.
With the final notice announced, MA organizations will go through the benefit package design process, considering the final risk adjustment model for 2024 payments and supplemental benefits (including margins, etc.,) towards the upcoming bid submission date of June 05, 2023 (the first Monday in June).
Navigate changes from the CMS Rate Announcement with Inovalon
With CMS introducing the blend of two risk adjustment models, risk score accuracy analytics and member targeting are now more complex and critical than previous years. Given 33% of the payments are going to be based on the 2024 CMS HCC v28 model, and 67% based on the 2020 CMS HCC v24 model, clinical documentation accuracy across both models becomes critical to ensure payments for member conditions.
Inovalon’s risk score analytics software, Converged Risk, and member outreach planning solution, Converged Outreach, are ready to support CMS’s final risk adjustment blended model.
Additionally, our Patient Assessment solution gives providers a lens into patients’ historical conditions, including the relevant care gaps, to accurately document all conditions at the point of care.
Now is the time to review your risk adjustment program to ensure your organization can meet CMS regulations. Our team is here to help your health plan succeed.
Ask us how we can help ensure appropriate member outcomes and economics according to the latest CMS guidelines.
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