CMS proposes more nontraditional benefits for MA plans
- Medicare Advantage plans will be able to offer more nonmedical supplemental benefits to patients with chronic illness under guidance CMS released Wednesday. The MA and Medicare Part D advance notice (Part II) and draft letter also put forward proposals aimed at combating the nation's opioid epidemic, such as encouraging cost-sharing reductions for patients with chronic pain or those receiving addiction treatment.
- The proposed policies build on a rule in effect this month allowing MA plans to include benefits like transportation to medical appointments and home meal delivery. "We've really opened it up now as part of this proposal to any benefit that improves or maintains healthcare," CMS Principal Deputy Administrator for Medicare Demetrios Kouzoukas told reporters.
- The expected average change in revenue for 2020 MA plans as a result of the policy changes would be an increase of 1.59%, the agency said, down markedly from the 3.4% increase for 2019.
Medicare Advantage enrollment is a growth area for payers aimed at seniors who want more benefits beyond traditional Medicare. The number of seniors in an MA plan rose 8% from 2016 to 2017, according to the Medicare Payment Advisory Commission. CMS has previously said 270 plans were offering the new, more flexible benefits for 2019.
Additional benefit options will be good news for companies looking to capitalize on growing awareness of the effects socioeconomic factors have on health outcomes. Uber and Lyft both have dedicated healthcare platforms, for example.
Also on the tech front, Apple is reportedly in talks with multiple MA plans, looking for partnerships involving the Apple Watch, which can help wearers track their activity levels, flag changes in heart rate and detect major falls.
CMS has been active lately in its proposals for the MA program. Earlier this month, the agency announced two new voluntary payment models, including one expanding access to telehealth and providing mechanisms to reward beneficiaries for healthy behaviors.
Part I of the advance notice, released in late December, proposed a change to the methodology for calculating risk adjustment payments for MA plans to include more encounter data. Comments on both parts are due by March 1, and CMS expects to release the final rate announcement and call letter by April 1.
In the proposals released Wednesday, CMS also suggested changes to its Part C and D star ratings methodology, including removing three measures starting in 2022 for "low statistical reliability." The measures are adult BMI assessment (Part C), appeals auto-forward (Part D) and appeal upheld (Part D).
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