A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program.

Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA).

A key provision of the bill is a proposed requirement that MA plans pay for hospice care. Hospice is currently “carved out” of Medicare Advantage. The potential impacts of moving hospice into MA at this time would be “devastating,” according to the National Alliance for Care at Home.

“Congressman Schweikert’s bill (HR 3467), while attempting to bring about wide-ranging changes to how Medicare Advantage operates, would also dismantle this vital program by forcing hospice care into Medicare Advantage plans,” an Alliance spokesperson previously told Hospice News in an email. “The consequences would be devastating … This proposal represents an unprecedented threat to end-of-life care. We implore Congress to reject it immediately.”

While that is the only hospice-specific element of the proposed bill, other changes to MA included in the text could have serious implications for hospices and other providers that also offer home health, palliative care or other services.

For one, if enacted, the bill would require all payments from MA plans to be capitated as of Jan. 1, 2028. The proposed legislation indicated two exceptions: special needs plans and MA plans that were made available in a particular region during the previous plan year.

If it were to become law, the bill would also reduce blended benchmarks for MA plans. Benchmarks are the maximum amount the government will pay a health plan for covering services for beneficiaries. The “blended benchmark” refers to a specific methodology for calculating those amounts.

Moreover, it would make changes to risk adjustment requirements. Beginning Jan. 1, 2028, risk adjustment for health status would be determined:

• using only diagnoses documented on claims from face-to-face or telehealth visits
• without using any diagnoses obtained for chart reviews or stand-alone health risk assessments
• using diagnoses from a 2-year period preceding the year for which such adjustment is made.

The bill would also allow the U.S. Department of Health and Human Services to establish stop-loss payment for Medicare Advantage plans that experience significantly higher than expected expenditures, as well as eliminate benchmark increases associated with quality. 

In addition, if enacted, the legislation would allow for the automatic enrollment of beneficiaries entitled to benefits under Medicare Part A, and who are enrolled in Part B, into the MA plan with the lowest available premium. Enrollees would have an opportunity to opt out of this enrollment.