.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:
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.
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.
The President’s proposed budget, quite similar to last year’s proposed “skinny budget,” allocates $68.4 billion to HHS, a 21% decrease or $17.9 billion less than what the agency received in fiscal 2017. Unfortunately, several proposals would have a negative impact on long-term services and supports: