CMS finalizes plan to expand MA benefits to include home air quality devices, food

CMS has finalized a plan to expand the supplemental benefits that people enrolled in Medicare Advantage can access. 

The Centers for Medicare & Medicaid Services released (PDF) its 2020 Rate Announcement and Final Call Letter on Monday evening which allows for coverage of such items as home air cleaners or carpet shampooing for beneficiaries with asthma, heart-healthy food and produce for people with heart disease or transportation to doctor’s appointments or educational meetings for diabetes patients.

On a call with reporters, CMS Administrator Seema Verma said that 27 million Medicare beneficiaries have at least one chronic condition, and management costs the program upwards of $342 billion each year. Allowing for these services, she said, helps beneficiaries stay healthy, promotes independence and allows MA plan sponsors to better individualize care.

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CMS also set a rate increase of 2.53% for the coming plan year, up from 1.59% in the draft version. Officials said they still expect risk scores to increase by 3.3% for 2020, when accounting for the underlying coding trend. 

The expanded supplemental benefits primarily target beneficiaries with chronic illness.

“Coverage is determined by what the person needs, not just what’s on a list of allowable services,” Verma said. 

In addition, CMS is moving forward with its plan to boost how much it relies on encounter data in calculating risk scores, despite significant push back in the comment period from MA plans

Beginning in 2020, encounter data—or information about patients’ medical conditions that comes from doctors and hospitals—will make up 50% of the data used to calculate risk scores. It accounted for just a quarter of the data used for the 2019 plan year. 

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Medicare Advantage insurers expressed concern that the data is often inaccurate or incomplete and called for CMS to pump the breaks on growing its use of such information in risk adjustment. 

The Blue Cross Blue Shield Association, for example, suggested a slower rollout and that CMS use 33% encounter data for 2020. 

However, Verma said on the call that the agency has worked hard to improve the accuracy and quality of such data, and thus feels confident that it should go ahead with the plan. 

“This has really been refined and we feel comfortable moving ahead,” she said.