Medicare Advantage Policy Spotlight

Two new policy actions open the door for partnerships between Medicare Advantage (MA) plans and community-based organizations (CBOs). These changes, which expand the flexibility of MA plans to target supplementary benefits to beneficiaries, are detailed in the Business Institute’s new Policy Spotlight.

The Policy Spotlight summarizes the new opportunities for CBOs made possible by the passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, a part of the Bipartisan Budget Act of 2018, and the release of final policy and payment updates to the MA program through the 2019 Rate Announcement and Call Letter. Both changes allow MA plans to expand the scope of the “primarily health-related supplemental benefit standard,” and update the uniformity requirements for supplemental benefits.

Together, these changes will increase the number of allowable supplemental benefit options and provide MA enrollees with access to benefits and services that may improve their quality of life and health outcomes. They also present a significant opportunity for CBOs to partner with MA plans.

With one out of three Medicare beneficiaries—19 million people—enrolled in MA plans, these changes are poised to have a significant impact. By specifying that these benefits need not be “primarily health-related,” the new rules and law provide flexibility for MA plans to partner with CBOs to provide a broader set of benefits that address social determinants of health. These may include services that address health and function, such as home-delivered meals, home modifications (e.g., installing wheelchair ramps), transportation and evidence-based health promotion and disease management programming.

CMS will provide supplementary guidance soon with more detail, however, MA plans generally have discretion about what supplemental or additional benefits to provide. The major stumbling block in the past has been that these supplementary benefits must be “primarily health-related,” which many health plans have narrowly defined. The CHRONIC Care Act, which becomes effective in 2020, redefines supplemental benefits as those that “have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee.”

CBOs have an important role to play in the health care system and should seek to partner with MA plans in their regions to provide supplemental benefits to beneficiaries with chronic conditions. These partnerships will better enable MA plans to provide high-quality care to the growing number of Medicare beneficiaries across the country who enroll in Medicare Advantage.

You can read the Policy Spotlight here.