February 20, 2015
NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and
Other Interested Parties
SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for
Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016
Call Letter
In accordance with section 1853(b)(2) of the Social Security Act, we are notifying you of
planned changes in the MA capitation rate methodology and risk adjustment methodology
applied under Part C of the Act for CY 2016. Also included with this notice are proposed
changes in the payment methodology for CY 2016 for Part D benefits and annual adjustments for
CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit. For 2016,
CMS will announce the MA capitation rates and final payment policies on Monday, April 6,
2015, in accordance with the timetable established in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA).
Attachment I shows the preliminary estimates of the national per capita MA growth percentage
and the national Medicare fee-for-service growth percentage, which are key factors in
determining the MA capitation rates. Attachment II sets forth changes in the Part C payment
methodology for CY 2016. Attachment III sets forth the changes in payment methodology for
CY 2016 for Part D benefits. Attachment IV presents the annual adjustments for CY 2016 to the
Medicare Part D benefit parameters for the defined standard benefit. Attachment V presents the
preliminary risk adjustment factors.
Attachment VI provides the draft CY 2016 Call Letter for MA organizations; section 1876 costbased
contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of AllInclusive
Care for the Elderly (PACE) organizations; and employer and union-sponsored group
plans, including both employer/union-only group health plans (EGWPs) and direct contract
plans. The Call Letter contains information these plan sponsor organizations will find useful as
they prepare their bids for the new contract year.
Comments or questions may be submitted electronically to the following address:
AdvanceNotice2016@cms.hhs.gov.
READ 2016 Advance Notice
NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and
Other Interested Parties
SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for
Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016
Call Letter
In accordance with section 1853(b)(2) of the Social Security Act, we are notifying you of
planned changes in the MA capitation rate methodology and risk adjustment methodology
applied under Part C of the Act for CY 2016. Also included with this notice are proposed
changes in the payment methodology for CY 2016 for Part D benefits and annual adjustments for
CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit. For 2016,
CMS will announce the MA capitation rates and final payment policies on Monday, April 6,
2015, in accordance with the timetable established in the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA).
Attachment I shows the preliminary estimates of the national per capita MA growth percentage
and the national Medicare fee-for-service growth percentage, which are key factors in
determining the MA capitation rates. Attachment II sets forth changes in the Part C payment
methodology for CY 2016. Attachment III sets forth the changes in payment methodology for
CY 2016 for Part D benefits. Attachment IV presents the annual adjustments for CY 2016 to the
Medicare Part D benefit parameters for the defined standard benefit. Attachment V presents the
preliminary risk adjustment factors.
Attachment VI provides the draft CY 2016 Call Letter for MA organizations; section 1876 costbased
contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of AllInclusive
Care for the Elderly (PACE) organizations; and employer and union-sponsored group
plans, including both employer/union-only group health plans (EGWPs) and direct contract
plans. The Call Letter contains information these plan sponsor organizations will find useful as
they prepare their bids for the new contract year.
Comments or questions may be submitted electronically to the following address:
AdvanceNotice2016@cms.hhs.gov.
READ 2016 Advance Notice
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