Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
By Lauren
Flynn Kelly, Managing Editor
August 10, 2017 Volume 23 Issue 15
Featured Health
Business Daily Story, Aug. 24, 2017
As lawmakers break this month from contemplating the future of the
Affordable Care Act (see story, p. 1), Congress has another pressing health
care issue to address: the permanency (or lack thereof) of Medicare Advantage
Special Needs Plans (SNPs). At the same time the Senate was heatedly debating
repeal-and-replace scenarios, a subcommittee of the House Ways and Means
Committee on July 26 held a hearing to examine the extension of SNP
authorization and ways to improve integration and coordination of care for
dually eligible Medicare-Medicaid beneficiaries. Experts interviewed by the
panel expressed support for extending the plans, but also urged Congress to
permanently authorize all SNP types and offered suggestions for additional
enhancements to the program, such as allowing seamless conversion to boost
enrollment into aligned plans.
SNPs were authorized under the Medicare Modernization Act of 2003
to serve institutionalized, dual-eligible or severe/disabled chronically ill
patients through 2008, and have since gone through a series of brief
reauthorizations, most recently with a provision in the Medicare Access and
CHIP Reauthorization Act of 2015 that allows them to operate through 2018.
Parallel bills have been introduced this year that address SNP reauthorization.
One is the Creating High-Quality Results and Outcomes Necessary to Improve
Chronic (CHRONIC) Care Act of 2017 (S. 870), which was approved by the Senate
Finance Committee on May 18 and — in addition to expanding telehealth and other
benefits for chronically ill patients — would permanently authorize SNPs (MAN
5/25/17, p. 1).
The other proposed legislation is H.R. 3168, which would grant a
five-year extension to SNPs in addition to requiring dual eligible SNPs
(D-SNPs) to become integrated by 2022, meaning the MA plan sponsor would have
to integrate the product with the state Medicaid program and take all the
Medicare and Medicaid risk on that plan. In the version discussed on July 26,
only institutional SNPs (I-SNPs) would be made permanent.
Approximately 11 million people are eligible for Medicare and
Medicaid coverage, but the majority of dual eligibles are not in programs that
integrate both benefits, pointed out Melanie Bella, former director for the CMS
Medicare-Medicaid Coordination Office (MMCO), during the hearing. More than 2.3
million individuals are currently enrolled in SNPs, and the bulk of that
enrollment is in D-SNPs. Bella testified that permanently extending D-SNPs is a
“critical piece” of advancing toward true clinical and financial integration of
the two programs, and that plans and other stakeholders “need the assurance of
stability to continue to invest both time and resources on increasing the
number of aligned plans and Medicare-Medicaid enrollees in those plans.”
Stakeholders Ask for Seamless Conversion
Furthermore, states and plans need mechanisms to ensure that dual
eligibles are enrolled in aligned plans, she argued. These include seamless conversion
of Medicaid enrollees who become eligible for Medicare into an aligned D-SNP,
which is not currently allowed. And MMCO could be given expanded authority to
align and simplify administrative requirements by working with states to, for
example, coordinate enrollment processes and conduct joint review of marketing
and enrollment materials, she added. The discussion draft contains language
establishing MMCO as a “dedicated point of contact for States to address
misalignments that arise with the integration of specialized MA plans for
special needs individuals,” and to establish a unified grievances and appeals
process for items and services provided by such plans.
Chris Wing, CEO of California not-for-profit SCAN Health Plan,
also testified at the hearing in support of SNP extension and other possible
enhancements to the program. SCAN serves about 185,000 seniors in California
and operates the state’s only Fully Integrated Dual Eligible (FIDE)-SNP, a
subset of D-SNP through which Medicare and Medicaid benefits are offered by a
single managed care organization. “If you’re not sure a program is going to be
around for more than a year, you really don’t want to invest too heavily in it,
so this is a big deal,” Wing remarks in a follow-up interview. “Even if we got
a five-year extension, that’s a totally different timeframe than a one- or
two-year extension.”
SCAN also welcomes a provision included in H.R. 3168 that would
provide new flexibility to MA plans to offer certain non-health care-related
services. Wing during the hearing gave an example of a $12 “wrist guard,” which
could enable a patient with both glaucoma and Parkinson’s Disease to administer
his eye drops from home and ultimately stay out of the emergency room and/or
long-term care. “It’s crazy that we can’t offer these Medicaid type of benefits
that could help improve care and radically reduce system costs for a Medicare
Advantage population,” he tells AIS Health.
Also testifying at the hearing was Larry Atkins, Ph.D., executive
director of the National MLTSS Health Plan Association, whose health plan
members serve about 70% of the managed long-term services and supports market
and about half of Medicare-Medicaid Plan membership through CMS’s Financial
Alignment Incentive demonstration. As part of the D-SNP integration requirement
in the proposed legislation, MCOs would have to enter into a capitated contract
with the state Medicaid agency to provide LTSS or behavioral health services,
or both. The coordination of care “across medical and non-medical sectors” not
only helps achieve higher care quality but manages spend effectively for states
and the federal government, Atkins stressed. Integrating medical and LTSS
coverage allows individuals to stay in their homes and communities for as long
as possible; avoid unnecessary ER visits, hospital admissions and readmissions;
and avoid or defer institutionalization, he added.
MLTSS Plans Argue for More Flexibility
Atkins said his association urges the committee to “permanently
reauthorize SNPs rather than continue them for another five years,
necessitating Congress to revisit and reauthorize the program yet again another
five years from now” and advocated for enhanced state flexibility to “require
that dual beneficiaries enrolled in an MLTSS plan be enrolled in an aligned MA
plan” (e.g., a FIDE-SNP or a D-SNP offered by the organization providing their
MLTSS coverage). He also cited challenges with states auto-enrolling their
Medicaid beneficiaries into managed care while Medicare beneficiaries can opt
to stay in traditional Medicare or in MA plans that do not align with their
Medicaid coverage, and agreed that the moratorium on seamless conversion should
be lifted.
Wing says he was “very encouraged” by the meeting and was
impressed with the “bipartisan enthusiastic support” that it demonstrated. “I
walked away feeling that this is actually going to happen, that we’re going to
get something done in Congress that will be helping truly the neediest
Americans when it comes to the health care system,” he adds.
View a replay of the hearing at http://tinyurl.com/y8pxp6yu.
https://aishealth.com/archive/nman081017-04?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=115901807
No comments:
Post a Comment