Medicare Advantage and Prescription Drug System May 2025 Payment Update
Relevant to: PDP, PACE, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
Disclaimer: The content provided on this site is a summary for informational purposes only, and Grane PBM, Inc. assumes no liability for any errors or omissions in the site’s content. The information does not constitute legal or regulatory advice or replace the original CMS memo. Readers are advised to consult the CMS memo in its entirety and to verify information independently before making any decisions based on this information.
For more details and information, please refer to the full memo on the CMS website.
Introduction
The May 2025 Medicare Advantage and Prescription Drug payment memo outlines important updates for all organizations involved. This includes details about payment adjustments, such as those related to the 2015 risk adjustment reconciliation reruns. Another key highlight is the conversion of the MARx system to an AWS cloud-based environment, which has introduced some complexities. Additionally, the memo discusses the ongoing sequestration suspension adjustments. For any queries, the MAPD Help Desk is available for assistance.
Key Dates and Deadlines
- Date of memo: April 30, 2025
- Scheduled receipt of May 2025 payment: May 01, 2025
- Publication date of the MARx August 2024 Payment memo: July 31, 2024
- Months affected by sequestration suspension: May 2020 through March 2022, April 2022 through June 2022, and July 2022 onward
PACE Compliance
This memo is relevant to PACE programs due to its implications on Medicare Advantage/Prescription Drug System (MARx) payments, which includes the May 2025 payment details impacting various organizations, including PACE.
The memo outlines adjustments related to the risk adjustment reconciliation for payment year 2015, which may affect payment amounts for PACE organizations if they have been involved in such arrangements.
PACE organizations need to be aware of the MARx system’s conversion to the AWS cloud-based environment, as this impacts the processing of payment, enrollment, and premium information. It’s important to note any discrepancies that may arise from this conversion, particularly those involving incorrect Part C and Part D risk scores, as these could affect payment calculations.
With the suspension of sequestration coming to an end, PACE organizations must apply the sequester percentages stated: 1 percent of retroactive payment adjustments for April 2022 through June 2022, and 2 percent of payments and adjustments for months starting July 2022.
In summary, PACE organizations should:
– Monitor adjustments due to the 2015 risk adjustment reconciliation reruns.
– Be vigilant of any discrepancies in MARx processing that might affect payments.
– Apply sequester percentages correctly to align with current payment policies.
Plans should ensure compliance with these outlined procedures to avoid payment inaccuracies or operational disruptions.
FAQs
- “What changes have been made to the Medicare Advantage/Prescription Drug (MA/PD) payment system in May 2025?”
- “How does the CMS address discrepancies in payment calculations following the migration to AWS?”
- “What is the significance of the 2015 Risk Adjustment Reconciliation Risk Adjustment Rerun?”
- “How is sequestration applied to retroactive payment adjustments after its suspension?”
- “Who should Medicare Advantage organizations contact for queries regarding the MARx system?”
For more details and information, please refer to the full memo on the CMS website.
