by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
On February 2, 2022, the 2023 Medicare Advantage and Part D Advance Notice was published by Centers for Medicare and Medicaid Services (CMS) with a comment period that ended March 4th. This important noticed focused primarily on how the government plans to advance health equity through the Medicare Advantage (MA) program to address inequities they believe exist in the various policies and programs that may prevent equal opportunity. They feel this is consistent with the Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government (EO 13985), an executive order from President Biden on January 20, 2021.
As these expectations of health equity are implemented throughout federal programs such as Medicare and federal funding of state programs like Medicaid, we will begin to see changes occurring in policies and reporting requirements within these programs.
CMS defines ‘equity’ as:
“The consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment.”
Through the Medicare Advantage (MA) and Part D programs, CMS is identifying ways in which they can advance equity, such as:
Collecting additional beneficiary data such as:
- Patient-specific social determinants of health
- Improve and implement quality measures that address health disparities
- Ensure Medicare dollars are spent on changes that drive health equity and close identified gaps
MA Organizations (MAOs) and Part D sponsors will play an important role in the government’s goal of advancing health equity by addressing the most critical gaps and barriers to equitable health care. Methods promoted in the publication touch on the MAOs ability to offer supplemental benefits that will address the existing gaps while still complying with federal requirements for offering supplemental benefits. CMS has created the Health Equity Technical Assistance Program, which provides additional resources for organizations who wish to promote health equity initiatives.
Additionally, another program that CMS will use to drive health equity is the Part D Star Ratings program by using federally-proposed quality measures that will specifically evaluate how MA plans are incorporating screening for common health-related social needs such as housing, food, and transportation insecurity among its beneficiaries. To learn more about this and other methodological changes proposed for 2023, see the Fact Sheet 2023 Medicare Advantage and Part D Rate Announcement and Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
- Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
- 2023 Medicare Advantage and Part D Rate Announcement
- Health Equity Technical Assistance
Disclaimer: The above article is the opinion of the author(s) and should not be interpreted by providers/payers as official guidance. For any questions about the content of this article, please contact the author(s).
About the Author: Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.