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Critical week for P.R.’s health system as ’19 Medicare funding deadline looms

A bipartisan effort led by Resident Commissioner Gonzalez and other stakeholders calls on CMS to correct Medicare Advantage payment disparity to aid in hurricane recovery.

The first week of April will be critical to the future of Puerto Rico’s healthcare system as the Centers for Medicare and Medicaid Services (CMS) will rule over numerous requests for improved treatment in the funding for Medicare Advantage programs on the island, the Medicare Advantage Products Association of Puerto Rico said.

These requests have come from the government of Puerto Rico, members of Congress, national health industry trade associations and the entire Puerto Rican healthcare community.

While the island’s MA payment issues existed well before the recent hurricanes, all these stakeholders recognize that the time for action is now more than ever if they hope to save Puerto Rico’s eroding healthcare system, the nonprofit stated.

“We’re awaiting the issuance of CMS’ final determination on MA rates for Puerto Rico. CMS’ decision will be critical for the current state of our health system,” said Rick Shinto, president of the MMAPA.

“We’re grateful that more leaders in Congress are willing to raise the issue of Puerto Rico’s insufficient funding for the MA program, which is evidenced by a wide gap in rates compared to all other jurisdictions,” he said.

A bipartisan effort in the U.S. House of Representative led by Puerto Rico Resident Commissioner Jenniffer González raised Puerto Rico’s case again in a letter addressed to the Secretary of Health and Human Services Alex Azar. Two-dozen Congressional representatives signed the letter dated March 16.

The letter raised the unfair treatment of funding for Medicare Advantage programs on the island.  Puerto Rico has one of the highest MA penetration rates in the U.S., with 75 percent of the eligible population enrolled in an MA plan, but the island receives 43 percent less funding than the national average. Approximately, 580,000 beneficiaries participate in the program in Puerto Rico, the trade group noted.

“Puerto Rico has lost 20 percent of its MA funding in the last six years. As a result of these dramatic cuts, the Puerto Rico system has an MA reimbursement rate that is 43 percent below the national average and 26 percent below that of its neighbors, the U.S. Virgin Islands,” the letter stated.

“That disparity must end if we are to have any hope of improving the island’s struggling health care system,” the group further noted in the letter.

MMAPA issued earlier in March its proposal for addressing the island’s disparity under the MA program. It requested that CMS use its administrative powers to improve MA rates based on proven anomalies in the data CMS uses to calculate rates for Puerto Rico.

MMAPA further requested that CMS consider the devastation caused by two hurricanes in September, Irma and María, the latter which has left large parts of the island without electric power six months after it made landfall.

Correcting this long-standing payment issue could have a meaningful impact on retaining providers, addressing growing healthcare needs, and rebuilding Puerto Rico’s healthcare system.

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

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