.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.

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. 

Subscribe to Transportation