High-level impacts of the proposed CMS-HCC risk score model on Puerto Rico Medicare Advantage payments for 2024

The 2024 Medicare Advantage (MA) Advance Notice includes a proposal to implement a clinically revised risk score model to be used for MA payments for calendar year 2024. The MA risk score model adjusts payments from the federal government to Medicare Advantage Organizations (MAOs) based on the expected cost to care for beneficiaries as a result of their demographics and medical conditions. Because the risk score model determines most of the payment amounts MAOs receive from CMS, changes to the model are expected to have significant implications on MAO revenue. This Milliman white paper provides an overview of the expected high-level impacts of these proposed changes by Medicare plan or population type for MA beneficiaries in the Commonwealth of Puerto Rico. The Puerto Rico specific MA payment reduction is 9.1%, which is significantly higher than the national average reduction of 3.4%.

This paper was commissioned by the Medicaid and Medicare Advantage Product Association of Puerto Rico (MMAPA).