Thanks to recent legislative and regulatory changes, Medicare Advantage (MA) plans for the first time can offer an array of non-medical services to Medicare beneficiaries. While the robust growth in MA plans’ use of these services reflects interest in these new offerings, the federal government can do more to help MA plan members understand these benefits. So says a new report released Tuesday.
ATI Advisory, the Long-Term Quality Alliance and The SCAN Foundation presented findings of the report — which offers a section for plans and providers, and one for policymakers — during a webinar the same day. The report is entitled “Delivering on the Promise of the CHRONIC Care Act: Progress in Implementing Non-Medical Supplemental Benefits.”
Historically, the Centers for Medicare and Medicaid Services required MA supplemental benefits, or benefits not covered by traditional Medicare, be “primarily health related.” That changed in 2019 when CMS reinterpreted the definition of “primarily health-related benefits,” expanding the scope of these benefits. Then, effective in 2020 was the creation of the Special Supplemental Benefits for the Chronically Ill (SSBCI) in the CHRONIC Care Act.
The latter resulted in an “unprecedented opportunity” to bring non-medical benefits to people with chronic conditions, Tyler Overstreet Cromer, principal of ATI Advisory, said Tuesday. Those benefits include everything from housekeeping to pest control to gym memberships.
MA plans are taking advantage of this newfound flexibility, Cromer noted. Some 19% of plans offered SSBCI in 2021. That rose from 6% in 2020, the report found. Meanwhile, 19% of plans will offer expanded primarily health-related benefits in 2022. Information on SSBCI data for 2022 is not yet available.
Room for improvement
Still, there is room to do better, particularly in beneficiary understanding of benefits and learning from results, the report found. “Plans wrestle with how to market these benefits while making it clear they are limited in eligibility,” the report said. Also, enrollment sources need clear information on these benefits to properly advise Medicare beneficiaries on their MA options.
Moreover, data collection could be stronger. “Data on these benefits and their outcomes are not being collected in a centralized manner and little progress is being made to fill the gap in the evidence base,” according to the report.
During the webinar, stakeholders weighed in about the new MA benefits, the challenges and the work ahead.
Katherine Peters, senior director of Medicare Product for Centene Corp., talked about finding ways to serve people who need the benefits the most. The non-medical benefits are expensive, she said. It’s important to “set reasonable expectations” of who should receive them and the eligibility criteria.
When partnering with plans it is important to know the requirements on both sides, said Kelly Cronin, deputy administrator at the Center for Innovation at Partnership at the Department of Health and Human Services.
“What is a Medicare Advantage plan need or Special Needs Plan? … What are all their requirements — everything from high-trust certification to exchange member data to performance expectations,” Cronin said.
To make sure that all the systems involved in offering the benefits are working together, it’s important to standardize quality across home care, noted Andrew Friedell, founder and CEO of healthAlign.
“I think a great starting place for that is the really good work that the states have done in kind of building a robust framework for regulating governing caregivers in under the home,” he said. “Some states may have no licensing requirement for some of these services. Other states, on the other end of the spectrum, will have very highly developed regulatory requirements for some of these services, and then there will be sort of hybrid states.”