CMS expands supplemental benefits for 2020 plan year

CMS has proposed expanding supplemental benefits in Medicare Advantage plans to include any benefit that “improves or maintains health,” particularly for the chronically ill population, the agency announced Jan. 30. MA plans will be able to more freely offer benefits such as meals and home modifications to better serve members with certain conditions.

The proposal would allow MA plans to add new benefits for the 2020 plan year, with more flexibility for plans to design benefits that are customized to suit specific chronic conditions, according to Demetrios Kouzoukas, CMS principal deputy administrator for Medicare and director of the Center for Medicare, who spoke during a press call Thursday.

The proposal, which was Part II of the 2020 Advance Notice of Methodological Changes for MA Capitation Rates and Part D Payment Policies (the Advance Notice), aligns with CMS’ expansion of benefits for the 2019 plan year, when the agency added in-home care services and other benefits. CMS released Part I of the Advance Notice on December 20, and will accept public comments on the proposals through March 1 before publishing the final rule on April 1.

“We recognize [many] Medicare Advantage beneficiaries have multiple chronic conditions,” Kouzoukas said. “These beneficiaries will have new options to improve their health.”

For the 2020 plan year, MA plans would receive an average increase in reimbursement of 1.59 percent, slightly below the 2019 average rate increase. CMS risk scores could increase 3.3 percent as a result of the underlying coding trend. The change in revenue does not include the risk score.

The expanded supplemental benefits will also extend to members who are receiving treatment for opioid abuse.

“The population of people who have payment issues and are undergoing addiction treatment qualify as chronically ill,” Kouzoukas said. “[This] allows plans to devise new and creative kinds of offerings … to best meet the health needs and provide a level of flexibility that had been previously unavailable.”

In addition, CMS also proposed adding flexibilities to Medicare Part D prescription drug plans by encouraging plans to lower cost-sharing for opioid-reversal agents.

The changes come as MA plans continue to absorb more of the Medicare population.

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” CMS Administrator Seema Verma said in a statement. “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.”