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CMS Finalizes 2015 Medicare Advantage Payment Policies

The Centers for Medicare & Medicaid Services (CMS) finalized April 7 payment policies for Medicare Advantage (MA) plans for calendar year 2015 in its rate announcement and final call letter. In particular, CMS finalized its proposal to adjust fee-for-service (FFS) claims from 2008-2012 when calculating 2015 MA payment rates. This adjustment will account for the Medicare disproportionate share hospital (DSH) payment methodology, which was mandated by the Affordable Care Act.

Beginning in fiscal year 2014, eligible hospitals receive 25 percent of their estimated Medicare DSH payments and separate uncompensated care (UC) payments based on the hospital’s relative UC. Without adjustment, the historical claims from 2008-2012 used to calculate the 2015 MA capitated payments would not accurately reflect the change to DSH and UC payments.

Please contact Zina Gontscharow, MPP, policy analyst, at zgontscharow@essentialhospitals.org or 202.585.0113 with questions.

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