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

October was an activity-filled month at LeadingAge. In addition to preparing for our successful Annual Meeting & EXPO in Philadelphia, we also launched a major new managed care initiative, advocated for nursing homes on several fronts, raised awareness about the role of technology, and weighed in on important issues in our field. Here’s a rundown of our work this month on your behalf.

Senate Aging Committee Chairman Susan Collins (R-ME) and Ranking Member Bob Casey (D-PA), held an October 3, 2018, hearing that focused on a variety of ways to reduce the cost of health care. The hearing featured witnesses representing patients, physicians, employers and insurers. Their testimony recommended restructuring Medicare payment policies from fee-for-service to value-based care arrangements, as well as other ideas to examine how innovation can help decrease cost, while improving patient outcomes.

These new supplemental benefit options were added in April 2018 when CMS announced in its Call Letter that it had re-interpreted the definition of “primarily health-related” opening the door to some limited home and community-based services being covered by MA plans who previously could only cover Medicare services. CMS applies some limits to the scope of these new benefits including they must be medically appropriate, and ordered or directly provided by a licensed provider as part of a care plan.  CMS also noted in its Call Letter that these benefits may be targeted or time limited. 

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