Nevada's Rosen opposes changes to Medicare Advantage funding formula

Mar. 30—U.S. Sen. Jacky Rosen is asking the Biden administration to reconsider a plan to update the Medicare Advantage funding formula, saying changes could have a disproportionately negative impact on beneficiaries living in rural areas.

Rosen, D-Nev., sent a letter Wednesday to Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure detailing concerns the proposed changes could lead to increased insurance premiums or reduced benefits.

"As you know, MA (Medicare Advantage) is an important and popular program that provides quality, affordable health coverage to over 28 million Americans, including more than half of all Medicare beneficiaries in Nevada," the letter said. "It is therefore imperative that any changes to the MA program take into account a wide range of beneficiary needs and concerns and do not lead to unintended consequences, including increased costs or reduced benefits."

Last week, the New York Times reported the Biden administration was seeking to change the payment formula in an effort to crack down on alleged widespread fraud within the Medicare Advantage program. Medicare Advantage is a health plan offered by private companies that contract with Medicare to include coverage for hospital stays, doctors visits and other benefits.

The Biden administration has proposed eliminating roughly 2,000 diagnosis codes from the funding formula, including for mild depression, vascular disease and diabetes with complications, according to the Times. Four of the largest five Medicare Advantage insurers have either settled or are tied up in lawsuits about fraudulent coding, the Times reported.

The administration says it has increased funding overall for the program by 9.5% over the past few years, and the reform is necessary to shore up the Medicare Trust Fund.

Rosen said Nevadans depend on Medicare Advantage for their zero-dollar premiums and comprehensive coverage of dental, hearing and vision care — especially those living in rural areas.

"For example, in Nevada's Nye County, a geographically large and less populated rural county, more than 60 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans," Rosen said in her letter.

"In particular, I have heard concerns from providers and stakeholders that the proposed changes to diagnosis codes could negatively impact the care delivered to Nevada seniors," she said. "With this in mind, I strongly urge CMS to take into account the full range of beneficiary concerns voiced throughout the public comment period before announcing the final CY 2024 policy."

In January, U.S. Department of Health and Human Services Secretary Xavier Becerra said the department expects to be reimbursed for as much as $4.7 billion in overcharges over the next decade.

The questionable payments are submitted through Medicare Advantage, a booming program that nearly half of the 60 million people enrolled in Medicare sign up for. The government spent $900 billion last year overall on Medicare, according to the Associated Press.

With the rise in popularity has come growing concern that insurers are ripping off taxpayers by overstating how sick a patient is to unlock higher reimbursements from the government.

The HHS Office of the Inspector General raised red flags about $6.7 billion worth of payments for patients whose diagnoses were not supported by medical records in 2017, according to the AP.

It's unclear when the proposed changes could go into effect, but a final say could be coming within days if not weeks, the Times reported.

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