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Life Health > Health Insurance > Your Practice

Data Demanded on Medicare Advantage Program

By Arthur D. Postal

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A House committee is asking the Department of Health and Human Services (HHS) whether it has used $8 billion in funds designated for Medicare demonstration projects to shore up the Medicare Advantage (MA) program.

The letter alleges that the funds were originally appropriated for use in demonstration projects aimed at finding out if changes in methods of payment and reimbursement would make healthcare delivery more efficient.

Instead, the letter implies, the money was used to make up for cuts in Medicare Advantage mandated by the Patient Protection and Affordable Care Act (PPACA).

The reports were requested by Rep. Fred Upton, R-Mich.,chairman of the House Ways and Means Committee; Rep. Cliff Stearns, R-Fla., chairman of the panel’s Oversight and Investigations Subcommittee and Rep. Joseph Pitts, R-Pa., chairman of its Health Subcommittee.

The letter cited an April 2010 report by the chief actuary of the Centers for Medicare and Medicaid Services (CMS) that said that payment cuts to MA mandated by PPACA would cut MA enrollment by 50 percent.

“Nevertheless, we note that the administration has taken credit for recent increased enrollment in the MA program and lower premiums on average, as well as for higher quality plan options,” the letter said.

“The administration claims that concerns about the cuts to MA plans in PPACA were overblown or inaccurate as evidenced by continued participation of plans and the aforementioned enrollment and premium numbers,” the letter said.

The letter asked for detailed data on how this occurred. One of the questions asked is, “Is this the most expensive demonstration every conducted by CMS” under authority claimed through Sec. 402 (a) of the Social Security Act?

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