.The new Special Supplemental Benefits for the Chronically Ill (SSBCI) likely holds the most interest for long term services and supports, housing and home and community-based service providers but lacks the detail around the services that can be provided. In 2020, MA plans will have the new option to offer “non-primarily health-related” supplemental benefits to chronically ill enrollees. These benefits do not need to be uniform across a population (e.g. all diabetics) and can vary based on each individual enrollee’s specific medical condition and needs.
On January 7, 2019, the Administration for Community Living (ACL) and the Centers for Medicare & Medicaid Services (CMS) announced the creation of the National Center on Advancing Person-Centered Practices and Systems (NCAPPS).
New Rules: The passage of legislation in 2018, such as the Bipartisan Budget Act of 2018 which contained provisions of the CHRONIC Care Act, will lead to changes in the types of benefits Medicare Advantage (MA) plans may offer in 2020 and beyond and what is expected of both MA and Special Needs Plans (SNPs). CMS closed 2018 with the publication of a series of proposed and final rules that will govern MA, SNPs, and Medicaid managed care plans for 2020 and beyond.
Here’s an overview of our work for you in December 2018.
The first report issued by the Long-Term Quality Alliance (LTQA) summarizes findings from interviews with seven Medicare Advantage organizations discussing how they approached the issue of whether or not to take advantage of the newly available HCBS supplemental benefits.The report notes that while the plans are enthusiastic about including these benefits that some key barriers remain to achieving that goal.
The National Council on Aging (NCOA) released this new tool in October of 2018, following a year of significant disasters and numbers of older adults who had been impacted across the country.
The Profile has proven to be a very useful statistical summary and serves as a resource for all professionals with an interest in the changing demographics of the population age 65 and over, including 15 topical areas (such as population, income and poverty, living arrangements, education, health, and caregiving).
CMS’s new interpretation appears to recognize the importance of these services for certain MA plan enrollees while making clear that not every enrollee in an MA plan will be eligible to receive them without a designated need. CMS identified the following list of specific services as allowable supplemental benefits meeting CMS’s new expanded definition of “primarily health related”:
These new supplemental benefits policies for Medicare Advantage plans are the result of two key policy actions: the 2019 Medicare Advantage and Part D Final Rate Notice and Call Letter issued by CMS in early April 2018 and the passage of the Bipartisan Budget Act of 2018, which include provisions of the CHRONIC Care Act. Both expand the definition of supplemental benefits that can be offered by MedicareAdvantage plans to their enrollees but the definitions and the timing of these changes are different.