CMS is proposing new personalization options for Medicare
Advantage plans aimed at improving value for members with chronic conditions.
January 31,
2019 - CMS is proposing
significant changes to Medicare Advantage geared towards expanding choice and
increasing competitiveness in a highly lucrative market.
The proposals
would increase the number and scope of supplemental benefits available to
Medicare Advantage (MA) members and would open up the option of tailoring
benefit packages to patients with certain chronic conditions.
“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,” said CMS Administrator Seema Verma.
“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.”
CMS is
soliciting comment on changes that would take place for the 2020 plan year,
including the option to create customizable plans to address the social determinants
of health for chronic disease patients.
Plans may have
the opportunity to add tailored coverage for non-emergency transportation or
home delivery of meals for individuals with food insecurity in an effort to
prevent crisis events and expensive utilization of emergency and inpatient
services.
“The Bipartisan
Budget Act of 2018 amended the statute to allow MA plans, beginning CY2020, to
offer non-primarily health related supplemental benefits to chronically ill
enrollees,” CMS explained.
“The law also
permits the Secretary, only with respect to supplemental benefits provided to a
chronically ill enrollee under the new provision, to waive uniformity
requirements, allowing MA plans to vary these supplemental benefits based on
the individual enrollee’s specific medical condition and needs.”
Because plans
do not have to be uniform, payers have the opportunity to create coverage
specifically suited for individuals with common challenges, such as a plan for
diabetics that focuses on offering dietary support.
“In the draft Call
Letter, we provide guidance about these new special supplemental
benefits for the chronically ill, including the definition of a chronic
condition and how to submit these benefits in the MA bid. We are soliciting
stakeholder feedback on this proposed guidance.”
The proposals
also suggest new ways to address opioid abuse within Medicare Advantage.
“CMS is
encouraging Medicare Advantage plans to take advantage of new flexibilities to
offer targeted benefits and cost sharing reductions for patients with chronic
pain or undergoing addiction treatment, and encouraging Part D plans to provide
lower cost sharing for opioid-1reversal agents,” the agency said.
Previous
changes to overutilization policies resulted in a 14 percent decrease in the
share of Part D beneficiaries using opioids between 2010 and 2017. The
largest decrease, 5 percent, took place between 2016 and 2017 as the focus on
opioid abuse sharpened at the federal and local levels.
CMS is
proposing that opioid use measures be included in the Star Ratings for Medicare
Advantage plans.
“We are
updating the methodology for measures currently on or under consideration for
our display page, including: Use of Opioids at High Dosage and from Multiple
Providers (OHDMP) (current display measure); Use of Opioids at High Dosage
(OHD) and Use of Opioids from Multiple Providers (OMP) measures (proposed
display measure); and Concurrent Use of Opioids and Benzodiazepines (COB)
(proposed display measure),” the agency stated.
“Reporting
measures on the display page is a necessary step before the measure can be
formally adopted as part of the Star Ratings through rulemaking.”
Additional
changes to the Star Ratings program include rating adjustments in 2020 for
plans experiencing “extreme and uncontrollable circumstances,” such as
hurricanes and other natural disasters.
The proposals
would also remove several measures in 2022, such as adult BMI assessment and
the number of appeals upheld, and would implement a temporary suspension of the
“controlling high blood pressure” measure to account for recent major changes
in clinical guidelines.
The changes are
intended to give beneficiaries a clearer understanding of how Medicare
Advantage plans operate while bringing additional value to consumers through
more personalized benefit options.
The public
comment period is open until March 1, 2019. The document will be
published in its finalized form no later than April 1, 2019. To share
commentary on the proposals, go to Regulations.gov
and enter docket number “CMS-2018-0154” in the search field.
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