“The regulation requires that MA benchmarks be dependent on a county’s ordinary Medicare FFS for each capita prices, and there is no proof that FFS prices in Puerto Rico are greater than the expenses noticed in the FFS promises facts and hence no basis for overhauling Puerto Rico’s MA benchmarks,” CMS wrote in the rate announcement in April.
CMS does not have a distinct threshold for a county’s Medicare Edge penetration when it will come to calculating fees, a CMS spokesperson explained. The company does use a “credibility adjustment” for counties with less than 1,000 beneficiaries in the common system to make the estimate more precise, she claimed.
Some in the business are hoping Congress can stage in and change the law for Puerto Rico outright.
A bipartisan team of lawmakers in the Home of Reps, which include Puerto Rico’s Resident Commissioner Jenniffer González-Colón (R), released a monthly bill in June that would produce a program in which Puerto Rico’s benchmarks could under no circumstances fall down below a specified level, which is increased than what final results from the latest method. The laws would also let the territory to put into practice the Medicare Savings System for 2024.
Beneath the monthly bill, insurers would have to spend at least half of any supplemental funds on elevated company payment.
“We’re not asking for parity. We’re not asking you to take us up to the national normal. Just give us a minimum—what our neighboring island, also a territory of the United States, gets,” García Rodríguez mentioned, referring to the Virgin Islands.
Edwin Park, a exploration professor at the Georgetown University McCourt College of Public Coverage, is skeptical of the argument that Puerto Rico insurers require significant improves in Medicare Gain payments. He believes Medicaid reform, for which the Medicaid and Medicare Edge Merchandise Affiliation of Puerto Rico also advocates, could have extra of an effects on the island’s healthcare procedure.
“It’s not the most efficient use of a constrained quantity of federal bucks,” he claimed. “If you want to assistance Puerto Rico’s health care method and in convert have all these ripple results in terms of the protection web, attracting suppliers, Medicaid is definitely the ballgame.”