Epstein Becker Green was recently featured in an America’s Health Insurance Plans (AHIP) email newsletter, titled “The MA Funding Formula Is Incorrect,” and a HealthPlanMarkets Alert, titled “AHIP Email: Wrong MA Formula Needs Fixing,” for its analysis of calculating Medicare Advantage (“MA”) payment rates.

Following is an excerpt from the HealthPlanMarkets Alert,“Wrong MA Formula Needs Fixing”:

The AHIP email cites an important new Epstein Becker & Green analysis backing the position by MedPAC that “certain counties are likely to have MA benchmarks based on FFS spending [that are] inaccurately measured” due to assumptions about congressional intent. The mistake: “inclusion in the AAPCC of costs attributable to beneficiaries enrolled only in Part A.” EBG, the leading U.S. health law firm, finds “Under a reading of the plain language of the statutory text cited above, Medicare Part A only beneficiary cost data should be excluded when calculating Medicare Advantage payment rates based on AAPCC.”

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