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’23 CMS Medicare Advantage base payment rates increase inequity for Puerto Rico

The Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA) expressed frustration that the Centers for Medicare and Medicaid Services (CMS) missed an opportunity to address long-standing inequities in Puerto Rico’s Medicare Advantage (MA) program with the new base payments for 2023.

The gap between payments on the island versus the national average remains wide and continues increasing annually, the organization stated.

Under the CMS determination, the average MA base payment for Puerto Rico in 2023 will be $644, compared with the U.S. average of $1,090.

This represents a widening gap in the absolute dollar difference between the mainland and the island compared to 2022, setting the new MA base payment for Puerto Rico at 41% below the national average; 37% below the state with the lowest rate; and 23% below the base payment for the territory of the U.S. Virgin Islands.

“Unfortunately, this disparity we’ve been fighting against for so many years, which ultimately impacts those dependent on federal health care programs, still places Puerto Rico well below even our neighboring jurisdiction,” MMAPA President Roberto Pando-Cintrón said.

“We call on the leadership of the U.S. Department of Health and Human Services (HHS) and leaders in Congress to act. The national focus on health care inequity by the Biden administration should not exclude Medicare beneficiaries in Puerto Rico,” said Pando.

“This is the time and opportunity to close the gap for Medicare Advantage payment rates and stand up for the American citizens in Puerto Rico,” he said.

Medicare Advantage provides health care services to more than 630,000 elderly individuals on the island, including the largest proportion of Medicare-Medicaid dual enrollee population of any U.S. jurisdiction.

Base payments for the MA program in Puerto Rico have historically been well below the average reimbursement in the states, negatively impacting beneficiaries’ health and leading to the mass exodus of health care professionals.

Puerto Rico’s health plans pay the same prices for prescription drugs as the mainland, are impacted by much higher utility costs, and must manage provider compensation in an open labor market that is inevitably competing with the MA plans of Florida, New York, and other states. This situation has led to the systemic neglect of health care infrastructure and inadequate professional compensation relative to the rest of the country, the group stated.

“We will continue working with CMS, Congress, and the government of Puerto Rico to reach a permanent solution that provides both patients and providers with the accessible, high-quality health care system they desperately need and deserve,” said Pando.

“The MA program has proven to be a platform that can make Puerto Rico a great case study of high-quality, cost-effective care, even in the face of such disparity. However, the clear gap in base payment rates remains harmful and must be brought in line, at the absolute least, with the current level of our neighbors in the U.S. Virgin Islands,” he added.

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This story was written by our staff based on a press release.

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