Section 3201. Medicare Advantage Payment

• Makes several adjustments to Medicare Advantage (MA) plan payments.
• Establishes care coordination and management performance bonuses for Medicare Advantage plans.
• The programs include:
  • Care management programs that:
    • Target individuals with 1 or more chronic conditions;
    • Identify gaps in care; and
    • Facilitate improved care by using additional resources like nurses, nurse practitioners, and physician assistants.
  • Programs that focus on patient education and self-management of health conditions, including interventions that:
    • Help manage chronic conditions;
    • Reduce declines in health status; and
    • Foster patient and provider collaboration.
  • Transitional care interventions that focus on care provided around a hospital inpatient episode, including programs that target post-discharge patient care in order to reduce unnecessary health complications and readmissions.
  • Patient safety programs, including provisions for hospital-based patient safety programs in contracts that the MA organization offering the MA plan has with hospitals.
  • Financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, capitation arrangements, or pay-for-performance programs.
  • Programs that address, identify, and ameliorate health care disparities among principal at risk subpopulations.
  • Medication therapy management programs that are more extensive than is required under the Medicare Part D program (as determined by the Secretary).
  • Health information technology programs, including clinical decision support and other tools to facilitate data collection and ensure patient-centered, appropriate care.
  • The Secretary shall provide for the annual auditing of programs described above for which an MA plan receives a care coordination and management performance bonus under this paragraph. The Comptroller General shall monitor auditing activities conducted under this subparagraph.

Applies to bid amounts submitted on or after January 1, 2012.

Applies to care coordination and management programs beginning with year 2014.