LeadingAge also asked CMS to provide more detail on the types of benefits a MA plan may offer under the new Special Supplemental Benefits for Chronically Ill policy and clarification on how these customized, person-centered benefits will be authorized. Additional comments were offered recommending ways for CMS to reduce provider burden by: 1) ensuring automation of crossover claims for dual eligibles enrolled in MA plans (currently, available in Medicare FFS and Special Needs Plans); and 2) eliminating duplicative reporting of basic provider information(e.g., name, address, NPI and license
.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.
LeadingAge is reading through the details of the Advance Notice and Draft Call Letter now and will provide a more detailed summary in the coming days. For now, here are a few highlights of what we know so far:
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 meeting brought together researchers, service providers, health plans, government officials, consumers, and their advocates around the central question of what is next for integrated care programs serving Medicare-Medicaid enrollees, those people who have coverage through both public health care programs.
As the population of older adults continues to grow, more and more are experiencing difficulties in finding and securing housing that is safe, affordable and that meets their needs.
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”:
As part of LeadingAge’s vision for integrated service models, we support efforts to address social determinants of health as those efforts can assist in ensuring quality of life and in some instances lowering medical care expenditures.