Legislation Introduced to Address MA Benchmark Cap

Senators Steve Daines (R-MT) and Angus King (I-ME) introduced legislation to enable certain Medicare Advantage (MA) plans to receive their full quality bonus payments.  Companion legislation has been introduced in the House by Reps. Ron Kind (D-WI) and Mike Kelly (R-PA).

The benchmark cap was implemented by the Affordable Care Act (ACA).  In general, the policy caps MA payments at the pre-ACA level.  In addition, the ACA established the Quality Bonus Payment (QBP) in the Star Rating system (incentive payments made to plans with four or more stars out of five).  The QBP includes a higher benchmark.  This means certain MA plans with high quality performance and corresponding high quality bonus payments will exceed the cap and will not be able to receive their full QBPs.  In addition, because the bonus payments must be used to benefit beneficiaries by reducing cost sharing or adding benefits, the benchmark cap has the effect of limiting these additional features for certain beneficiaries.

Additional information about the Senate bill is available here.


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