Issuers can add new types of benefits
based on two separate rule 'reinterpretations.'
Starting in 2019, Medicare Advantage plans can
cover adult day care services, and in-home help with activities such as
dressing, bathing and managing medications, a top Trump administration official
said Wednesday.
Seema Verma, the administrator of the Centers
for Medicare and Medicaid Services (CMS), talked about the Medicare Advantage
program’s new benefits flexibility at a Medicare conference at CMS
headquarters, in Baltimore.
CMS announced the rule reinterpretations in
April, in a memo sent to potential 2019 Medicare Advantage plan
issuers. It is not yet clear whether any issuers will add significant
chronic care supplemental benefits for 2019, although
executives from Humana Inc. hinted during their first-quarter
earnings call that they might be able to work with partners to do so.
Verma told insurance company executives at the
conference that CMS hopes its new “reinterpretation” of the Medicare
Advantage program benefits rules will help unleash private-sector innovation
and creativity.
She said she has seen the effects of that
creativity in her own life.
“Both my parents are enrolled in a Medicare
Advantage plan, and they can’t stop talking about them,” Verma said, according
to a written version of her remarks distributed by CMS.
A copy of the speech is available here.
The Old Rules
The Medicare Advantage program lets private
insurers use a combination of government money and patient premiums to provide
an alternative to traditional Medicare coverage.
In the past, managers of Medicare Advantage
have tried to simplify the plan shopping process, and discouraged plans from
offering benefits that might drive up health care costs, by putting tight
restrictions on the kinds of benefits a plan issuer can offer.
Those restrictions kept plan issuers from
adding benefits such as adult day care benefits, except when the plans
were participating in CMS pilot programs or other special programs.
The New Rules
Verma said CMS now wants to let plans offer
benefits that can compensate for physical impairments, reduce the impact of
injuries, or reduce avoidable use of emergency rooms.
Verma did not use the term “long-term care,”
or “short-term care,” but the benefits she described appear to be similar to
the kinds of benefits many private long-term care insurance policies through
home health care and community care provisions.
Plans can also add supplemental benefits
tailored to meet the needs of people with specific conditions, Verma said.
Staff Presentation
Details
Also at the conference, two other CMS
employees, Heather Kilbourne and Brandy Alston, presented a slidedeck that gives benefits flexibility details.
A “zipped” packet of conference presentations
is available here.
The CMS staff members noted that CMS
is offering benefits flexibility through what legally are two separate
interpretations: a supplemental benefits interpretation and a benefits
uniformity flexibility interpretation.
The new interpretations are separate from the
chronic care benefits versions in the Bipartisan Budget Act of 2018. The
BBA-2018 provisions will further expand the range of Medicare supplemental
benefits chronically ill enrollees can get starting in 2020, the staffers said.
Supplemental Benefits
Plans adding benefits based on the
supplemental benefits interpretation must make sure the benefits
are ”primarily health related,” and not primarily for a patient’s comfort.
The services covered must be recommended by a
physician or other licensed medical professional as part of a care plan.
The new benefits must not include items or
services used to induce enrollment.
A plan can choose to help individuals
both with basic “activities of daily living,” such as walking, and with the
“instrumental activities of daily living,” such as taking medications
correctly.
Uniformity Flexibility
The new “uniformity” flexibility interpretation
will let a plan tailor benefits, such as deductibles or wellness options, to
fit people with certain medical conditions, such as diabetes.
That interpretation will not let a plan tailor
benefits based on an enrollee’s income or poverty level, or any other
characteristic other than health status, the officials said.
Plans must use “objective and measurable”
criteria to identify eligible enrollees.
Allison Bell, ThinkAdvisor's
insurance editor, previously was LifeHealthPro's health insurance editor. She
has a bachelor's degree in economics from Washington University in St. Louis
and a master's degree in journalism from the Medill School of Journalism at
Northwestern University. She can be reached at abell@alm.com or on Twitter at
@Think_Allison.
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