Gardner Expresses Concern With Proposed Changes to Medicare Advantage

Washington, DC – Senator Cory Gardner (R-CO) today sent a letter to the Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), Andrew Slavitt, expressing concerns with several proposed changes to the Medicare Advantage (MA) program. Specifically, the Senator writes that the proposed changes to the Risk Adjustment, Employer Group Waiver Plans, and Encounter Data could have a negative impact on more than 250,000 Coloradans who rely on their MA plans. Gardner, troubled that these changes could disrupt the quality of care in the MA program, asks that CMS carefully consider the consequences of the proposed changes to payment and bidding models to ensure stability for beneficiaries in Colorado. 

The letter reads in full: 

I write to express concerns with multiple proposed changes in the 2017 Advance Notice that would impact Medicare Advantage (MA). I have serious concerns that these changes could negatively impact beneficiaries, including senior citizens, in my state and strongly encourage your agency to reconsider these proposals. 


According to Centers for Medicare and Medicaid Services (CMS), more than 17 million seniors and individuals with disabilities enjoy the high quality affordable coverage provided by MA plans. Medicare Advantage plans are an especially popular option in Colorado. That is why I am concerned that the proposed changes to the Risk Adjustment, Employer Group Waiver Plans, and Encounter Data could negatively impact the MA plans of more than 250,000 Coloradans which represents nearly 37 percent of seniors in Colorado who currently enjoy the advantages of MA plans. 


I am concerned the proposal to change the risk adjustment models could have adverse effects on seniors and individuals with disabilities. Independent analysis of these changes shows an average reduction of nearly two percent in funding as a result.  This reduction could weaken early detection and prevention efforts of chronic conditions provided by MA plans. These services have proven to reduce long-term costs to the health care system for high cost individuals, while also improving health outcomes for individuals.


Additionally, I ask your agency to carefully consider the consequences of the proposed alterations to payment and bidding models for Employer Group Waiver Plans. These changes have the potential to disrupt the level of care depended on by millions of seniors. Further, I am concerned that your agency acted unilaterally by putting these proposed changes forward when there has been bipartisan opposition to these efforts in the President’s budget request. 


Lastly, I ask that your agency reconsider the Encounter Data proposal that would raise the percentage of risk calculations from 10 percent to 50 percent. A 2014 GAO report found that encounter data systems have had several unresolved operational problems and limit the ability to receive accurate information on the patient history of our beneficiaries. I urge you to reassess the expansion of encounter data until studies show it can accurately capture beneficiary diagnosis.  


Any changes to the MA program must maintain stability for the millions of Americans who benefit from the patient-centered, affordable care currently offered. As the final notice is approaching in early April, I strongly recommend that CMS reconsider the proposed changes and preserve program integrity.


Cory Gardner is a member of the U.S. Senate serving Colorado. He sits on the Energy & Natural Resources Committee, the Foreign Relations Committee, the Commerce, Science, & Transportation Committee, and the Small Business & Entrepreneurship Committee, and is the Chairman of the Subcommittee on East Asia, the Pacific, and International Cybersecurity Policy. 

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