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Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

Keohane LM, Rahman M, Thomas KS, Trivedi AN. Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans. Journal of the American Geriatrics Society. 2018 May 1; 66(5):992-997.

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OBJECTIVES: To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). DESIGN: Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012. SETTING: Select MA plans. PARTICIPANTS: Members of 27 plans with mandatory cost sharing reductions (n = 132,000) and members of 21 plans without such reductions (n = 138,846). MEASUREMENTS: Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. RESULTS: In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI) = 153.2-163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI = 3.8-24.8 days, p = 0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI = -6.5-20.8, p = .30). Disenrollment patterns did not change after the cap took effect. CONCLUSIONS: When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change.

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