Press Release

RELEASE: Alliance of Community Health Plans Responds to Medicare Advantage Payment Rules


Contact:  Charlie Patterson,

Erin Grandstaff,

Alliance of Community Health Plans Responds to Medicare Advantage Payment Rules

Suggests Trump Administration Executive Order on ACA as avenue to restore quality payments

Washington, D.C.  (March 3, 2017) – The Alliance of Community Health Plans (ACHP) submitted comments today in response to the Medicare Advantage Advance Notice and Call Letter. President and CEO, Ceci Connolly, issued the below statement summarizing ACHP’s priorities as argued in their comments:

“Restoring quality payments under the benchmark cap is crucial to ACHP, for both our plans and for seniors who have lost millions of dollars in benefits. Fortunately, the President’s Executive Order issued on January 20 grants new authority to HHS that could effectively restore quality payments.”

As outlined in ACHP’s comments:

ACHP urges CMS to finally correct the substantial losses to America’s seniors from implementation of the benchmark cap. CMS can use new authority granted in the President’s executive order of January 20, 2017 to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act” that imposes a burden, cost, or penalty on individuals, families, health plans, and others. We have previously provided legal analysis documenting how the law provides discretionary authority, and that authority is strengthened further by the executive order. CMS’ interpretation to date has reduced or eliminated quality payments to plans in about half the nation’s counties. That in turn has cost tens of millions of dollars in Medicare benefits to about 2.5 million seniors who enrolled in high quality plans so they could take advantage of enhanced benefits. It is time to fix this problem for the 2018 plan year.

“We believe that the Executive Order gives HHS clear authority to level the playing field and dismantle a framework that currently penalizes the highest quality Medicare Advantage plans in the country and the seniors who choose those plans.

Our comments also flag a little known loophole in the Medicare Advantage star rating system. We ask CMS to correct inappropriate consolidation of Medicare Advantage contracts by organizations seeking to boost their star ratings. The Medicare Payment Advisory Commission (MedPAC), an arm of Congress, also has highlighted this problem.  When plans can take steps to manipulate those ratings by moving enrollees to a higher performing plan resulting in a cash windfall for them and no measurable improvements in care for their patients, then we have a real problem – both in terms of quality of care and in the form of a substantial misallocation of resources. Plain and simple, there needs to be a way to prevent plans from gaming the Medicare Advantage program.”




About ACHP
The Alliance of Community Health Plans (ACHP) is a national leadership organization bringing together innovative health plans and provider groups that are among America’s best at delivering affordable, high-quality coverage and care. ACHP’s member health plans provide coverage and care for more than 19 million Americans, including 2.3 million Medicare beneficiaries, across 27 states and the District of Columbia. These organizations focus on improving the health of the communities they serve and are on the leading edge of innovations in affordability and quality of care, including primary care redesign, payment reform, accountable health care delivery and use of information technology. Six of the 14 5-star combined Medicare Advantage/Prescription Drug plans are ACHP member plans, in addition to two 5-star, MA-only plans. Eighty-five percent of enrollment in 5-star plans is in plans offered by ACHP members. To learn more, go to and follow ACHP on Twitter @_ACHP.