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 CMS Unveils Updates for Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) has finalized updates that it says will increase competition among Medicare Advantage (MA) plans by enlarging the list of options they can pay for, as the agency broadens the definition of supplemental benefits.

CMS Administrator Seema Verma said the actions are being taken at a time MA enrollment is at an all-time high, and to make sure plans have greater flexibility in offering benefits and “that they focus on preventing disease and keeping people healthy.”  

The updates follow steps taken in 2018 by CMS to expand the definition of health-related supplemental benefits that MA plans could offer to enrollees, where the primary purpose of the benefits are daily maintenance of health.

“Beginning in 2019, MA plans can now offer supplemental benefits that are not covered under Medicare Parts A or B, if they diagnose, compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” the agency said.

As an example, MA plans may offer adult day health services and/or in-home support services under the expanded definition of supplemental benefits when they meet these standards. 

And for 2020, CMS said the new updates would give patients with chronic illnesses who are under MA coverage the possibility of accessing a broader range of supplemental benefits that are not necessarily health-related, “but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees.”

These benefits, CMS said, can address social determinants of health for beneficiaries with chronic disease. “For example, beneficiaries enrolled in an MA plan could now receive meal delivery in more circumstances, transportation for nonmedical needs like grocery shopping, and home environment services in order to improve their health or overall function as it relates to their chronic illness.”

In addition to the changes for MA plan options, CMS said it has taken steps to help battle the opioid crisis by encouraging MA plans to take advantage of new flexibilities to offer targeted supplemental benefits, cost-sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide at least one opioid-reversal agent on a lower cost-sharing tier.

CMS said the agency’s crackdown on overutilization of opioids (prescriptions) has led to a 14 percent decline in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

A fact sheet on the 2020 Rate Announcement and Final Call Letter is at www.cms.gov/newsroom/fact-sheets/2020-medicare-advantage-and-part-d-rate-announcement-and-final-call-letter-fact-sheet.

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