tci Part B Insider - 2015 Issue 41

CMS to Scrutinize VBID Participants

The new Value-Based Insurance Design (VBID) model for Medicare Advantage (MA) Plans appears to give plans a wide berth when redesigning benefits for targeted enrollees. But there are many safeguards in place, ensuring that CMS will definitely be watching plans closely. CMS has built into the model design a variety of protections for enrollees. Chiefly, MA Plans are not allowed to propose reductions in targeted enrollee benefits or increases in targeted cost-sharing amounts as VBID interventions. Also, MA Plans cannot discriminate against non-targeted populations, for example, by making changes to plan benefits in ways that decrease benefits to enrollees...

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