Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Aug 9th, 2022

On April 4, 2022, CMS finalized the 2023 MA capitation rates, as well as the Part C and Part D payment policies, in this publication: CMS CY 2023 Rate Announcement. As is standard for each annual update, the CY 2023 Capitation Rate Tables are available for review and download on the CMS Ratebooks and Supporting Data website.

In the Calendar Year 2023 Advance Notice, CMS described plans for a more focused approach to advancing health equity through the collection and analysis of data such as race, ethnicity, and social determinants of health. CMS plans to focus on the development of quality reporting measures, enhanced methodologies for measuring and addressing health disparities, and using all of these to drive value in healthcare. Focus will also include ensuring every dollar spent is focused on addressing programmatic changes in an effort to close health equity gaps. One thing CMS noted was that all commenters on the rule expressed a common support for the promotion of health equity. 

As part of the goal to advance initiatives to close the gap on health disparities, CMS requested input on the following specific topics: 

How to improve the Medicare Advantage and Part D Star Ratings 
How to incorporate factors related to health equity and social determinants of health into risk adjustment models
Considerations when assessing the geographic level of rate setting for ESRD beneficiaries and its potential implications for health equity

Included in the Rate Announcement are eight attachments that address the following: 

1. Final estimates of the following are used to calculate the CY 2023 capitation rates:
   • National Per Capita MA Growth Percentage for CY 2023
   • National Medicare Fee-for-Service (FFS) Growth Percentage for CY 2023
   • National Per Capita Medicare Advantage (MA) Growth Percentage for CY 2023
   • National Medicare Fee-for-Service (FFS) Growth Percentage for CY 2023
2. Key assumptions and financial information behind growth percentages
3. CMS responses to Part C payment-related comments from the 2023 Advance Notice
4. CMS responses to Part D payment-related comments from the 2023 Advance Notice
5. Part D benefit parameters, including the details of how they are updated
6. CMS responses to comments on updates for MA and Part D Star Ratings
7. Economic information related to the CY 2023 Rate Announcement
8. Relative factors for the following two risk adjustment models:
   • 2023 CMS-HCC ESRD
   • 2023 RxHCC 

The Rate Announcement also includes key updates such as growth percentages for both Medicare Advantage and Medicare Fee-For-Service (FFS) programs as well as the calculation of FFS costs. Policies that are published in the Advance Notice, but are not modified or retracted in the Rate Announcement, take effect in the upcoming calendar year. Any clarifications made in the final Rate Announcement will supercede those that were published in the Advance Notice. A complete listing of the policies to be adopted in CY 2023 are listed in the Rate Announcement as well. If you spent time in the Advance Notice, it is time to dig into the Rate Announcement to see what has become finalized for CY 2023. 

About Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.