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House Members Urge Tavenner to Account for SES in the MA program

November 21, 2014—Reps. Diane Black (R-Tenn.) and Earl Blumenauer (D-Ore.), along with 32 colleagues, sent a Nov. 14 letter to Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner asking that social determinants of health, such as socioeconomic status (SES), be incorporated in the Medicare Advantage (MA) program’s risk-adjustment payment model and the star rating and quality bonus program.

The letter expresses concerns that the current MA payment system does not adequately recognize the types of high-cost interventions and care management required to provide high quality care to the unique and specific needs of dually-eligible beneficiaries. It further suggests that CMS make necessary adjustments, such as those advised by the Medicare Payment Advisory Commission (MedPAC) and the National Quality Forum (NQF) to recognize SES and dual-eligible status, in both the risk adjustment system and the star rating and quality bonus program [see Washington Highlights, Mar. 31]. 

Despite additional resources and commitment from healthcare providers, the letter adds that, “improved health outcomes tend to occur at a slower rate for the most disadvantaged beneficiaries. This, in turn, leads to lower quality ratings for the plans serving these populations and ultimately, lower funding to these plans. Thus, our current system perpetuates a downward funding and quality spiral for the populations who may need the most help.”

The letter further asks CMS to “take appropriate measures to ensure Medicare’s most vulnerable populations will continue to have access to the high quality of care provided through the Medicare Advantage program,” and adds that the MA program is vital to such beneficiaries as dual-eligible and low-income seniors “who often experience higher rates of chronic illness, disability and mental illness.”


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Courtney Summers
Senior Legislative Analyst
Telephone: 202-862-6042


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806