Some important changes were recently made to the Medicare Advantage (MA) program through the passage of the CHRONIC Care Act and new rules published by The Centers for Medicare and Medicaid Services (CMS).
What’s Different Now?
Medicare Advantage (MA) plans and providers who work with them will soon have greater flexibility to offer additional supplemental non-medical benefits to address the health of people with chronic illnesses. Some of these changes are due to the inclusion of some provisions of the CHRONIC Care Act in the Bipartisan Budget Act, which was signed into law earlier this year. (This is separate from policies related to chronic care management billing codes for Medicare.) Others are a result of new rules recently finalized by CMS.
- Beginning in 2019 under the new CMS rules:
- Plans will be allowed to tailor supplemental benefits to beneficiaries’ specific disease conditions, rather than being required to offer these benefits uniformly to all plan participants. For example, plans could offer enrollees with diabetes more frequent foot exams with lower cost-sharing.
- Plans may offer supplemental benefits if they are used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to improve the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization—allowing them to provide non-skilled in-home supports such as in-home workers, retrofitting for things like wheelchair ramps and healthy meals.
- Plans will get an average 3.40 percent increase in revenue from CMS payments, an increase over the 1.84 percent increase initially proposed by CMS.
- Beginning in 2020 under the new law:
- Plans will be allowed to offer supplemental benefits that are not primarily health-related as long as the benefit has a reasonable expectation of improving or maintaining the health or overall function of the beneficiary. This will allow plans to focus services like nonemergency transportation toward individual chronically ill beneficiaries.
- Medicare Special Needs Plans (SNPs) will be permanently reauthorized. SNPs are permitted to target enrollment to one or more types of special needs individuals, including those who are (1) institutionalized, (2) dually eligible for both Medicare and Medicaid, or (3) living with severe or disabling chronic conditions.
- Plans can offer additional, clinically appropriate, telehealth benefits.
What does this mean for you?
- If you partner with one or more Medicare Advantage plans, you may be able to contract to provide a broader range of services.
- You may also receive increased payments for your services, based on the increased CMS payment rate to Medicare Advantage plans for 2019.
If you have any questions, please contact Sarah Dobson, Director of Public Policy and Advocacy, at firstname.lastname@example.org or 202-499-5832.