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As discussed in our recent
post on the new Medicare Advantage (MA) star ratings, there is
ongoing controversy regarding HHS's Medicare Advantage Quality Bonus Payment
Demonstration Project. The Demonstration Project is
intended to test an alternative method for computing quality bonus
payments and, unlike the quality bonus payment structure under the
Affordable Care Act, it allows for the payment of quality bonuses
to MA plans with less than four stars. Although HHS believes
that the project provides a strong incentive for MA plans to
improve performance at various star rating levels, critics have
questioned the design, efficacy, and true intentions of the
project. This summer, the House Committee on Oversight and
Government Reform held a hearing on the project where experts from the Government Accountability Office
(GAO) raised concerns regarding the project and recommended its
cancellation.
Now, Congressional Republicans are threatening to issue a
subpoena if HHS does not produce requested documents regarding the
Demonstration Project. In an October 17th letter, House Oversight Committee Chairman Darrell Issa (R-CA) stated that if the
Committee did not receive all requested documents by 5:00 p.m. on
October 18, 2012, it would "move ahead with the use of
compulsory process."
MA plans will want to closely monitor the outcome of this back
and forth between HHS and the Committee. Without the
Demonstration Project, MA Plans will be subject to the Affordable
Care Act's quality bonus provisions and only those plans with a
star rating of 4 stars or higher will be eligible for quality bonus
payments.
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