The IRA changes the categories that count toward TrOOP spending, including payments for previously excluded supplemental benefits provided by Part D sponsors and EGWPs and excluding payments under the new Manufacturer Discount Program. CMS indicates that Part D sponsors must update their systems ...
Understanding RADV is important to appreciating the impact of this rule. Avalere has an excellent review of the rule and RADV.They explainthat CMS pays MA plans a capitated amount per member per month on a risk-adjusted basis using the CMS Hierarchical Condition Category (HCC) ri...