|
As expanded supplemental
benefits offered by Medicare Advantage plans continue to grow and attract
enrollees, a new report from the Government Accountability Office (GAO)
observed that there is still limited data on the extent to which
beneficiaries are using these benefits. GAO suggested that CMS could do
more to collect data on supplemental benefit use from MA organizations and
recommended that it issue clarification on current encounter data reporting
requirements.
More plans are offering
supplemental benefits
- “CMS…want[s] to understand where the dollars are going,
making sure that they’re getting good value for their
investments,” remarks Tim Murray, a principal with the actuarial and
consulting firm Wakely Consulting Group, an HMA company. “I think if
Medicare Advantage as an industry is going to be able to make a
data-driven case that supplemental benefits are actually driving
sustainable value for members beyond marketing sizzle, then this issue
will need to be addressed and remedied.”
- According to the GAO
report, over 99% of MA plans offered at least one traditional
supplemental benefit, while about 34% offered at least one of the
newer types of benefits, expanded primarily health-related benefits
(EPHRBs) and Special Supplemental Benefits for the Chronically Ill
(SSBCI), that were first allowed in 2019 and 2020, respectively.
Nearly one-fourth of the plans in GAO’s analysis offered at least one
EPHRB in 2022, and 69% of these plans offered only one such benefit,
while 31% offered two or more of the five benefits reviewed. Offered
by 17.3% of plans, in-home support services was the most popular type
of EPHRB, followed by support for caregivers of enrollees (6%).
- More than one-fifth of plans offered at least one SSBCI
in 2022. At 14.7%, food and produce was the most popular SSBCI type,
followed by meals beyond a limited basis (6.6%).
CMS should clarify
encounter data requirements
- Yet the extent to which members are using these
benefits is limited, and CMS’s current guidance on encounter data
“does not specifically mention or discuss the submission of encounter
data for supplemental benefits,” GAO wrote.
- GAO concluded that the encounter data system remains
the agency’s primary means of collecting information on enrollees’ use
of supplemental benefits and thus made two recommendations. First, it
asked that CMS clarify guidance to MA plans on the extent to which
encounter data submissions must include data on the utilization of
supplemental benefits. Second, it advised that CMS “take actions to
address circumstances where submitting encounter data for supplemental
benefits is challenging for MA plans, such as when a given benefit
lacks an applicable procedure code.”
- Because some of these benefits were recently introduced
to the MA market, the confusion around reporting requirements is
justified, observes Murray. “For example, how should reporting for
flex benefit cards work when one beneficiary might use the allowance
for pest control services and another beneficiary might use the flex
card allowance to subsidize dental out-of-pocket expenses?”
- Moreover, the current guidance “is maybe not quite
caught up with the benefit innovation that has happened over the last
few years,” he suggests. “The structure of encounter data is more
aligned with the traditional medical physician encounter, but how does
one capture the details for an encounter” when it involves, for
example, a contractor working in a beneficiary’s home to install a
bathroom safety device or an in-home provider showing up to help with
household chores or provide companionship?
|
No comments:
Post a Comment