Puerto Rico forecasts effects of high Medicare Advantage enrollment

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“The regulation calls for that MA benchmarks be in line with a county’s reasonable Medicare FFS consistent with capita prices, and there is not any proof that FFS prices in Puerto Rico are upper than the prices noticed within the FFS claims knowledge and thus no foundation for overhauling Puerto Rico’s MA benchmarks,” CMS wrote within the fee announcement in April.

CMS does no longer have a selected threshold for a county’s Medicare Merit penetration relating to calculating charges, a CMS spokesperson stated. The company does use a “credibility adjustment” for counties with fewer than 1,000 beneficiaries within the conventional program to make the estimate extra correct, she stated.

Some within the business are hoping Congress can step in and alter the regulation for Puerto Rico outright.

A bipartisan team of lawmakers within the Area of Representatives, together with Puerto Rico’s Resident Commissioner Jenniffer González-Colón (R), offered a invoice in June that will create a machine through which Puerto Rico’s benchmarks may just by no means fall underneath a definite degree, which is upper than what effects from the present machine. The law would additionally permit the territory to put into effect the Medicare Financial savings Program for 2024.

Beneath the invoice, insurers must spend no less than part of any further finances on higher supplier fee.

“We’re no longer soliciting for parity. We’re no longer asking you to take us as much as the nationwide reasonable. Simply give us a minimal—what our neighboring island, additionally a territory of the USA, receives,” García Rodríguez stated, relating to the Virgin Islands.

Edwin Park, a analysis professor on the Georgetown College McCourt College of Public Coverage, is skeptical of the argument that Puerto Rico insurers want huge will increase in Medicare Merit bills. He believes Medicaid reform, for which the Medicaid and Medicare Merit Merchandise Affiliation of Puerto Rico additionally advocates, will have extra of an have an effect on at the island’s healthcare machine.

“It’s no longer the best use of a restricted quantity of federal greenbacks,” he stated. “If you wish to lend a hand Puerto Rico’s healthcare machine and in flip have these kinds of ripple results in the case of the security web, attracting suppliers, Medicaid is in point of fact the ballgame.”