The newly released 2019 Advance Notice and draft Call Letter proposes easing several restrictions around Medicare Advantage benefit design, which reflects the administration’s theme of “empowering” MA plans.
“The many flexibilities — a new broad definition of supplemental benefits, health condition specific benefits, geography specific benefits — have the potential to significantly change Medicare Advantage, by letting MAOs embrace leading practices from the employer and Medicaid markets,” says Michael Adelberg, a principal with FaegreBD Consulting and a former top CMS MA official.
CMS would redefine health-related supplemental benefits to include those that “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”
John Gorman of Gorman Health Group describes the expansion of supplemental benefits as the best news the industry has gotten in years. He says, “It’s going to become the primary weapon plans use to address social determinants of health.”
The Call Letter also calls for uniformity flexibility, which would allow MA plans to reduce cost sharing, offer specific supplemental benefits, and lower deductibles for enrollees under certain medical situation. It permits Special Needs Plans (SNPs) for dual eligible and institutionalized patients to offer specialized, targeted care through enhanced disease management programs. The letter adds provisions on ensuring quality and transparency as well.
However, there were few meaningful changes to the star ratings in the Call Letter. The most notable was CMS’s confirmation that it will use an enrollment-weighted average to determine the quality rating of consolidated contracts.
CMS says it will continue to evaluate SNP-specific network adequacy evaluations and expects to provide further instructions in a future memo or the final rule.