After the changes in the recommendation to improve the Medicare Advantage (MA) risk-adjustment system and pay Program of All-Inclusive Care for the Elderly providers based on the MA payment system take effect, the Secretary should establish an outlier protection policy for new Program of All-Inclusive Care for the Elderly sites to use during the first three years of their programs to help defray the exceptionally high acute care costs for Medicare beneficiaries.
The Secretary should establish the outlier payment caps so that the costs of all June 2012 recommendations about care coordination programs for dual-eligible beneficiaries do not exceed the savings achieved by the changes in the recommendation above.