At SafeRide Health, we are committed to helping the country’s most vulnerable Medicare Advantage (MA) and Medicaid member populations access care through non-emergency medical transportation– particularly those in underserved communities.
With the final payment rule released in late March by the Centers for Medicare and Medicaid Services (CMS), Medicare Advantage payments will be raised by 3.32% in 2024 rather than their initial proposal of 1%, representing a ~$13.8 billion increase.
This enables our MA health plan partners to continue improving health outcomes and member experience among their member populations– and continue closing gaps in care equity for those with the highest health disparities. Rather than adjusting budgets to meet the initial 1% payment increase target, our health plan customers are able to better meet their members’ needs with the final payment increase of 3.32%. (Note that the initial 1% payment increase target was modeled by health plans to be a 2.27% cut, influenced by changes to Star ratings calculations and risk adjustment models.)
This final ruling is a major victory for our MA partners and the 30+ million beneficiaries enrolled in Medicare Advantage plans who were staring down the risk of reduced benefits and higher premiums, two key factors in an increasingly competitive MA market.
Another major consideration coming out of this final rule relates to risk adjustment for MA health plans, which will be phased in over a three-year period. This involves the transition of the coding system from Internal Classification of Diseases (ICD)-9 to ICD-10, the coding system healthcare professionals have been using for years. This phased-in risk adjustment from one to three years is a significant change financially and operationally for our MA health plan partners. A key concern around these risk adjustment shifts is the potential implications around diverting resources away from dually-eligible and underserved beneficiaries, which make up a large proportion of the member populations for several of our health plan partners. Research indicates that the more than 2,000 codes proposed for elimination would disproportionately impact the most vulnerable populations, lowering the risk scores of dually eligible members at a far higher rate.
At SafeRide, we believe that transparency and data-driven decisions are vital at every point in the healthcare journey. While we stand behind the goal of simplifying and removing ambiguity from risk adjustment scores, we fully support a phased approach where unintended downstream impacts can be monitored and considered. The goal of this final rule is to ensure stability and payment integrity among MA health plans, and beneficiaries will be able to continue receiving the health care that they need – particularly those facing barriers to care access.
This hits close to home for us at SafeRide as we partner with MA health plans to administer intuitive, technology-powered non-emergency medical transportation programs. With this final ruling, we remain excited about the future as we continue to innovate alongside our MA health plan partners on the best ways to get the most vulnerable member populations to life-sustaining care.