U.S. Senator Pat Toomey (R-Pa.) has sent a letter to the Centers for Medicare & Medicaid Services (CMS) acting director Marilyn Tavenner expressing concern at a decision that will shrink Medicare Advantage (MA) benefits for millions of seniors.
Over 14 million seniors, including 800,000 in Pennsylvania, have chosen to enroll in a Medicare Advantage plan for comprehensive health coverage. Unfortunately, the president's health care law significantly undermines the Medicare Advantage program, eliminating $308 billion from the program over the next ten years. Recently, CMS revealed that they would not include an anticipated suspension or fix to the sustainable growth rate (SGR) in calculating 2014 MA rates. Instead, they chose to calculate rates based on the highly unlikely scenario that Congress would allow draconian cuts to the physician fee schedule to take effect on January 1, 2014. By refusing to include an "SGR fix', CMS reduces the value of benefits MA plans are able to offer to seniors. These benefits may include such items as glasses, hearing aids, and dental cleanings.
Recognizing an "SGR fix' in the 2014 MA benchmark will not result in additional cost to taxpayers.
"Approximately 38% of Pennsylvania's Medicare beneficiaries have chosen to receive coordinated health care through a Medicare Advantage plan. I'm troubled that the Centers for Medicare & Medicaid Services have consciously chosen a course of action that would reduce health benefits for more than 800,000 Pennsylvanians," said Sen. Toomey. "It is critical to ensure appropriate Medicare Advantage reimbursement. I firmly believe that a sound Medicare Advantage program can contribute to Medicare's long term sustainability and preserve the program for future generations. I look forward to an answer from Ms. Tavenner soon."
The full letter is below:
March 22, 2013
Centers for Medicare & Medicaid Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201
Dear Ms. Tavenner:
We are concerned with the Centers for Medicare and Medicaid Services' (CMS) recent decision to calculate 2014 Medicare Advantage (MA) rates with the assumption that the Medicare physician fee schedule would be subject to a 25 percent reduction on January 1, 2014. CMS made this conscious choice despite strong historic precedence of Congress repeatedly intervening to avert scheduled cuts to the physician fee schedule.
Over fourteen million seniors have chosen to enroll in a Medicare Advantage plan, opting for comprehensive and coordinated health coverage. A recent national survey revealed that nine out of ten Medicare Advantage beneficiaries were satisfied with their plans. Unfortunately, the President's health care law significantly undermined the Medicare Advantage program, eliminating $308 billion from the program over the next ten years. According to the Congressional Budget Office (CBO), these reductions are anticipated to reduce MA enrollment by 23 percent.
In the Advance Rate Notice and Draft Call Letter published on February 15th, CMS deliberately chose not to exercise their discretion to anticipate a suspension or fix to the sustainable growth rate (SGR). Instead, they chose to calculate 2014 MA rates based on the highly unlikely scenario that Congress would allow draconian cuts to the physician fee schedule to take effect. We respectfully request that CMS re-examine their statutory authority to address this issue and revise their estimates and calculations in a manner which anticipates that physician rates will remain at their current levels. Failure to acknowledge Congressional precedence on the SGR along with significant cuts in the President's health law will result in further destabilization of the MA market and reduced access for millions of seniors.
We recognize the importance of ensuring appropriate MA reimbursement and believe that a sound Medicare Advantage program can contribute to Medicare's long term sustainability and preserve the program for future generations.
We appreciate your consideration and look forward to your timely response.
Pat Toomey, US Senator
John Cornyn, US Senator
John Boozman, US Senator
Dean Heller, US Senator