House members raise concerns over Medicare Advantage demonstration project

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HHS Secretary Kathleen Sebelius
HHS Secretary Kathleen Sebelius

Republican members of the House Ways and Means Committee have accused the Department of Health and Human Services of overstepping its authority in implementing a controversial Medicare Advantage demonstration project.

The project, a provision of the Affordable Care Act, grants quality bonuses to Medicare Advantage plans with three stars or more, and speeds up bonuses for four-star plans. The demonstration project also boosts the bonuses given to plans with four or more stars.

The lawmakers have asked the Department of Health and Human Services to hand over all correspondences concerning the program. Government actuaries estimate the program will cost $8.3 billion over 10 years.

In a letter to HHS Secretary Kathleen Sebelius, Reps. Dave Camp (R-MI) and Wally Herger (R-CA) echoed concerns raised by the Government Accountability Office and the Medicare Payment Advisory Commission over the size and cost of the program.

“With its most recent report, GAO has determined HHS exceeded its legal authority to implement this demonstration, which calls into question all activities surrounding the development of the MA QBP [quality bonus program],” the letter states.

Like fee-for-service Medicare, Medicare Advantage plans cover skilled nursing facility stays following acute episodes and other post-acute care. MA also includes special needs plans for chronically ill and disabled individuals such as dual eligibles.