AMGA Objects to Medicare Advantage Rate Cuts
AMGA today recommended the Centers for Medicare & Medicaid Services (CMS) reconsider the cut in the proposed benchmark rate for Medicare Advantage (MA) plans and the continued phase-in of the new Hierarchical Condition Categories (CMS-HCC) model.
CMS Proposal Adds to Financial Uncertainty Facing Providers
Alexandria, VA – AMGA today recommended the Centers for Medicare & Medicaid Services (CMS) reconsider the cut in the proposed benchmark rate for Medicare Advantage (MA) plans and the continued phase-in of the new Hierarchical Condition Categories (CMS-HCC) model.
In comments on the Advance Notice of Methodological Changes for Calendar Year (CY) 2025, AMGA noted the cut in the proposed benchmark rate does not account for increased demand for healthcare services. Given this increased demand, if CMS finalizes the proposed changes to the benchmark rate, it will create uncertainty in the MA program. AMGA members are facing an unexpected reduction in MA reimbursements, while also contending with a significant cut to Medicare Fee-For-Service (FFS) payment rates. Cutting the benchmark rate for MA will only exacerbate financial pressure on providers. CMS should recalculate the benchmarks, which AMGA contends does not recognize the increase in utilization resulting from care being delayed due to the COVID-19 pandemic.
“AMGA providers have come to rely on the Medicare Advantage program for its payment stability and predictability,” said AMGA President and CEO Jerry Penso, MD, MBA. “CMS’ proposal is adding uncertainty into the mix, which is difficult given the challenges providers are facing with increased costs and demands for services.”
While concerned about the benchmark rate cut and continued change to the CMS-HCC model, AMGA fully supports CMS' use of the Universal Foundations set, which is intened to reduce provider burden on reporting quality measures. Since 2018, AMGA endorsed a streamlined set of quality measures to simplify the reporting process and limit the burden on providers and group practices while reporting clinically relevant and actionable data.
AMGA’s comments on the proposed rule are available on AMGA’s website.
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About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.
AMGA represents medical groups and integrated systems of care. Its diverse membership includes multispecialty medical groups, integrated delivery systems, accountable care organizations, and other entities committed to improving healthcare outcomes. AMGA advocates for the formation of innovative, clinically integrated systems of care that advance population health, enhance patient experience, and reduce healthcare costs. For more information, please visit www.amga.org.