Medicare Advantage gets supplemental benefits flexibility, including for transport
- A CMS final rule gives Medicare Advantage plans additional flexibility in determining what supplemental benefits to offer certain beneficiaries, including for non-medical benefits like meal delivery and transportation.
- The change, part of a broad Medicare payment rule for 2019, means that MA plans do not have to offer the same supplemental benefits to all chronically ill enrollees, but can tailor those benefits to specific medical problem and needs.
- The rule takes effect June 15, and opens the door for MA plans to offer benefits, such as for ride-hailing services like Uber and Lyft.
Specifically, the rule requires a nationwide revision of the Medicare Advantage Value-Based Insurance Design model, which allows participating MA plans to offer targeted supplemental benefits. MA plans must still offer all enrollees uniform benefits, premiums and cost sharing.
Under the bipartisan budget deal signed by the president in February, Congress expanded supplemental benefits for the chronically ill to include those that “have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.”
The law also authorizes CMS to waive uniformity requirements, but only with respect to supplemental benefits for enrollees with chronic conditions.
As healthcare’s focus shifts increasingly to population health, barriers such as transportation and food and housing insecurity are entering the equation of what it means to be and remain healthy. Without a reliable ride, for example, patients may miss scheduled appointments or fall treatment regimens, increasing the likelihood of more costly care in the future.
Ride-hailing company Lyft applauded the move.
“This guidance demonstrates how serious CMS is in giving health plans the tools they need to address the social determinants of health — of which transportation is foundational,” Laure Belive, director of federal government relations at Lyft, said in a statement. “This new flexibility will allow us to partner even more dynamically with MA plans, to not just help seniors suffering from chronic health conditions get to their health appointments, but to more broadly leverage our platform to remove transportation barriers, and encourage healthy and active living.”
Both Lyft and Uber have tapped into the lucrative patient transport business through health system and payer partnerships. In November, Lyft teamed up with Cigna-Health Spring to provide rides to and from doctors and pharmacies to customers in select MA plans.