Reform Could Cut Provider Pay: Study

The Senate proposal on MA is “markedly” different than what is proposed under the House bill, the MWE analysis said.

The House bill would phase in benchmarks equal to the adjusted average per-capita cost estimate payable under traditional fee-for-service Medicare. The House bill would initiate the transition beginning with the 2011 benefit year, while the Senate proposal would initiate the transition with the 2012 benefit year, the analysis pointed out.

Currently, local benchmarks reflect an adjusted community rate for each county, which have been updated annually over the past several years, according to the Healthcare Law Reform Insights blog created by MWE.

To calculate plan payments, MA providers annually submit bids for their plan benefit packages that are compared to the benchmark for the counties in the plan’s service area.

Under the Senate bill, benchmarks by fiscal year 2015 would equal enrollment-weighted averages of local MA plan bids for each service area, the lawyers said. A ceiling would be established in each area so that local benchmarks could not exceed the levels that would have existed under current law.