The possibility that the cut of 11% on rates of Medicare Advantage (MA) 2016 is suspended for Puerto Rico is still latent.
At least, that was reflected in a letter sent to them by the Secretary of Health in the United States, Sylvia Burwell, Gov. Alejandro Garcia Padilla and Resident Commissioner Pedro Pierluisi.
According to the document, which is dated last Friday, it will be next Monday, June 8, upon completion analysis being made by the Center for Medicare and Medicaid Services (CMS, for its acronym in English) on the case of Puerto Rico.
The analysis responds to a request made different groups of health care providers in the country. They claim that the calculations used to estimate the rates for the Medicare Advantage program in Puerto Rico are wrong and lead to wrong rates, which do not respond to the reality of the services that are offered on the island.
This claim is bound to petition the federal government to the healthcare industry in the country has spent years trying to hold: the gap between expenditure on the Island and those of other US jurisdictions.
‘In Medicare have a number of disparities in the treatment given to Puerto Rico and that impacts our health system,’ said Pierluisi.
Burwell acknowledged the ‘difficult fiscal situation’ through Puerto Rico and Medicare Advantage is a ‘critical part’ in the Medicare program in Puerto Rico by the number of insured serving.
‘This is another indication of discriminatory treatment received by Puerto Rico in federal programs for their territorial status. It falls from the tree that our status is unfair. We have stuck and we all aspire to equality in federal programs, ‘said Pierluisi.
Contrary to the United States, most policyholders in Puerto Rico Medicare subscribe to Advantage plans, not traditional Medicare. Local Tuition Advantage plans is around 560,000 people.
‘I share your concern about the impact on beneficiaries (result) of the reductions to the MA rates,’ says Burwell in the letter.
However, the official cautioned that CMS also understood that most of the recommendations submitted by Advantage plans operating in Puerto Rico ‘are not consistent with the statute.’
Still, Burwell said CMS has not had enough time to evaluate the technical questions for fixing rates and they expect to conclude their analysis time for next Monday.
CMS recognizes concerns
Meanwhile, Queen Becnel, public affairs officer of CMS, said written MA rates for 2016 would not be reviewed.
‘CMS has no legal authority to change Medicare Advantage rates for 2016 were already published on April 6,’ he said.
According Becnel said during the announcement of the rates issued in early April, CMS agreed to investigate a technical issue that brought him representatives of Puerto Rico MA plans. However, he said that as the situation was not called to their attention until recent days, CMS does not have time to confirm whether the problem alleged by the MA plans to Puerto Rico exist or if the matter can be addressed now.
‘In the final notification of tariffs we undertook to examine the issue of how our policies are working to fix rates in Puerto Rico to determine whether an adjustment should be made to the rates of 2017,’ said Becnel.
The official recalled that many MA plans in Puerto Rico have led them questions about the implementation of Advantage and Part D program in Puerto Rico.Medicare Part D refers to the prescription drug coverage.
Question other exceptions
Dennis Rivera, spokesman for the Coalition for Justice for Medicare in Puerto Rico, acknowledges that CMS argues that the questions that have led various sectors of health in Puerto Rico are of a statutory nature and could take them into consideration for the 2017 tariff review.
However, through the renowned lawyer Harold Ickes, the Coalition presented some exceptions in which CMS acted. ‘We present documents that they had (check rates even beyond the date of the final notification of tariffs),’ Rivera said. According to the union leader, the most important thing is that the letter of Burwell remains hopeful that their concerns are considered.
‘It keeps the issue alive. This I is not dead and there are other efforts (lobbying), ‘he said.
Require attention to impact
Ricardo Rivera, director of the Health Insurance Administration (ASES) reported that its analysis CMS on this issue should take into account the implications of their actions.
‘That 11% (reduction in rates in Puerto Rico MA 2016) have an implication on a quarter of a million people, 250,000 Medicare insured Platinum’ he said.
He recalled that it is anticipated that the cuts could cause migration of these 250,000 secured to the Government Health Plan (PSG), which would impose an additional burden to the government about $ 800 million within two to three years. This calculation, he said, is based on the monthly contribution of $ 260 per beneficiary that the government would have to provide in Medicare Platinum insured when they are part of the PSG.
Meanwhile, Orlando Gonzalez, President of MMM (MMM) reported that this issue must be addressed with urgency since yesterday was the deadline for the MA 2016 products.
‘The crossroads is that if the report contains positive information for Puerto Rico, you may have to wait until 2017 for implementation. If the information is not positive, Puerto Rico would continue to be exposed to more cuts in funding, ‘he said.
The pediatrician Victor Ramos, president of the College of Physicians and Surgeons, agreed yesterday was a key to the Advantage plans product delivered their proposals for next year date.
‘We must keep the pressure and see what happens,’ the pediatrician.
Francisco Rodriguez Burns contributed to this report.