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CMS expands ability of MA plans to tackle social determinants of health for the chronically ill

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Medicare Advantage has been a centerpiece of the CMS effort to push forward alternative payment models and the agency has started ramp up the opportunity for MA plans to cover benefits that address beneficiaries’ social determinants of health.

CMS officials have widened the scope of issues that plan sponsors can address through the finalization of its 2020 Medicare Advantage rules.

“The Trump Administration is committed to strengthening Medicare to allow beneficiaries to achieve historic new benefits that address the social determinants of health,” said CMS Administrator Seema Verma in a call with reporters.

The policy change builds on previous efforts by CMS to encourage better management and maintenance of health by allowing increased flexibility for plan dollars to pay for services like adult care programs and the installation of home safety devices like grab bars and wheelchair ramps.

These supplemental benefits were approved for coverage if they diagnosed conditions, compensated for physical impairments, diminished the impact of injuries or reduced ED utilization. Previously, supplemental benefits only consisted of “primarily health related” services.

In accordance with the Bipartisan Budget Act of 2018, CMS has expanded supplemental benefits for 2020 to cover services that can be used to support beneficiaries with chronic conditions and specifically tailored for individual patients.

According to research from CMS, around 20.7 million Medicare beneficiaries suffered from two or more chronic conditions leading making up $260 billion in annual healthcare costs.

“MA plans are given a budget, a maximum level of what they can spend and that’s why they can have the flexibility to offer those benefits,” Verma said. “It allows plans to treat patients’ health more holistically. They can see what a patient needs and tailor benefits accordingly.”

Some examples include coverage of home air cleaners or carpet shampooing for an asthma patient, delivering heart healthy food for a patient with cardiovascular disease or non-emergency transportation for a diabetes patient struggling to make it to appointments.

Verma said addition of these so-called Special Supplemental Benefits for the Chronically Ill are an effort to create more competition among MA plans, with the intention to drive better outcomes at lower costs.

She added that the benefits expansion allows for “private market innovation” to address chronic disease in an individualized manner.

Alongside the expansion of the services covered by Medicare Advantage, CMS also finalized a 2.53 percent payment increase for plans in 2020. The increase is higher than the initial 1.59 percent jump projected by CMS in December.

Photo: diego_cervo, Getty Images

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