GAO Wants CMS to Enhance Data Collection Efforts Around Supplemental Benefit Use

Today's Featured Story   GAO Wants CMS to Enhance Data Collection Efforts Around Supplemental Benefit Use   by Lauren Flynn Kelly   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?    From Radar on Medicare Advantage   Subscribers may read the in-depth article online. Learn more about subscribing to AIS Health's publications.