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CMS Announces CY 2021 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies

April 07, 2020

McDermott+Consulting

On April 6, 2020, the Centers for Medicare and Medicaid Services released the annual capitation rates for calendar year 2021 for Medicare Advantage (MA) and Part D. The agency states these adjustments and new policies will continue to advance, modernize, and increase competition within MA and Part D.

The final capitation rates are based on the National Per Capita MA growth percentage and the fee-for-service (FFS) growth percentage. CMS expects the average change in revenue will be 1.66%, an increase from the initial expected change in revenue of 0.93%. Additionally, CMS finalized its proposed continued phase-in of the risk adjustment model and its proposed blend of encounter-based and Risk Adjustment Processing System scores; and finalized the rates for end-stage renal disease.

Many plans and providers have asked CMS to confirm that it will allow telehealth encounters to count for risk adjustment purposes and requested guidance from CMS regarding the inclusion of diagnoses from telehealth visits in risk adjustment. CMS indicates it will issue separate guidance on this topic.

CMS has indicated a call will be scheduled for stakeholders to discuss the 2021 Rate Announcement, as well as COVID-19 related guidance for MA organizations.

 

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For more information visit the McDermottPlus Payment Innovation Resource Center or contact Mara McDermott at 202-204-1462 or mmcdermott@mcdermottplus.com.

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