CMS planning to expand supplemental benefits in Medicare Advantage for members with chronic illness 

Medicare enrollment form and pen
CMS wants to allow Medicare Advantage plans additional flexibility to provide supplementary benefits to people with chronic conditions. (Getty/zimmytws)

The Centers for Medicare & Medicaid Services is looking to further expand options for Medicare Advantage plans to provide supplementary benefits to beneficiaries with chronic conditions. 

CMS issued (PDF) the second part of its 2020 Advance Notice and Draft Call Letter Wednesday evening, and in it the agency aims to offer greater flexibility for MA plans to meet the needs of chronically ill patients.

“Today’s proposals build in additional flexibilities to continue to increase choice and competition for beneficiaries,” Demetrios Kouzoukas, CMS deputy administrator for Medicare, said on a call with reporters.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The annual letter sets rates for MA plans and often includes other incremental policy changes. For 2020, CMS is proposing an average 1.59% rate increase, a slight decrease from rates for the 2019 plan year, though these figures could change by the time they’re finalized in April. Accounting for the underlying coding trend, CMS says risk scores could increase by 3.3% for 2020. 

RELATED: 8 Medicare and Medicaid reforms that would have the biggest impact on federal spending 

CMS allowed Medicare Advantage plans to offer more supplemental benefits for 2019, and Department of Health and Human Services Secretary Alex Azar teased that there were plans to further expand those benefits for 2020

Kouzoukas said that MA plans will be able to offer any benefit that improves or maintains the health of beneficiaries with chronic conditions and could also allow them to lower cost-sharing for services specifically pertaining to the management of those illnesses. 

Supplemental benefits could include meal deliveries, Kouzoukas said, or home modifications to allow for home care. These flexibilities are crucial, because many Medicare beneficiaries have multiple chronic conditions to manage. 

MA plans will not be required to offer supplemental benefits, he said, but it is another tool in their arsenal to improve care management and bring down costs. 

RELATED: CMS gives states permission to waive Medicaid’s IMD exclusion, expanding mental health treatment 

CMS Administrator Seema Verma said in a statement that it’s crucial for the agency to continue offering new options within MA as enrollment in such plans continues to grow. Estimates project MA could account for as much as 42% of the Medicare population by 2028, and about 34% of Medicare beneficiaries were in an MA plan for 2018. 

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in their Medicare benefits,” Verma said. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

CMS will accept comments through March 1 with plans to finalize the letter by April 1.

Suggested Articles

A group of House lawmakers want CMMI's mandatory kidney care model to be as narrow as possible and change how it calculates payments.

Humana and Microsoft announced a seven-year strategic partnership to build predictive solutions and intelligent automation to support Humana members.

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.