Medicare Advantage: Supplemental Benefits & Payment Reform

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Presentation transcript:

Medicare Advantage: Supplemental Benefits & Payment Reform Mike Hoak, Director of Public Policy November 9, 2018

Overview of Common Medicare Advantage Supplemental Benefits Hearing Aids Dental Premium Buy-Down & Cost Sharing/OOP Max Reductions Vision

Changes to MA Supplemental Benefits in 2019 The Centers for Medicare and Medicaid Services (CMS) issued regulations in April 2018 providing plans with greater flexibility to offer more tailored and more diverse supplemental benefits beginning in 2019. Targeted Cost Sharing Reductions Tailored Benefits Wider Range of Potential Benefit Offerings Plans can provide reduced cost sharing for certain services for beneficiaries with targeted conditions. For example, plans could reduce the cost sharing amount for diabetes members visiting their endocrinologist. Plans can elect to offer certain benefits solely for members with certain targeted conditions. For example, plans could cover more frequent foot exams as a tailored benefit for diabetes members. Plans can elect to cover a wider range of supplemental benefits for members with targeted conditions, including adult day care services, home-based palliative care, in-home support services, and non-Medicare covered safety devices.

“ 2019 Will Be a Learning Year Plans Had Little Time to Prepare A supplemental benefit is not primarily health related under the previous or new definition if it is an item or service that is solely or primarily used for cosmetic, comfort, general use, or social determinant purposes The new regulations and sub-regulatory guidance were issued only weeks before final MA bids were due to CMS. Social Determinants of Health Were Excluded Plans were prohibited from using supplemental benefits to address social determinants of health, such as food insecurity. CMS, April 27, 2018 HPMS Memo Plans Will Have Even More Options in 2020 Congress passed legislation in 2018 providing plans with even more supplemental benefit flexibility beginning in CY 2020.

Changes Coming for 2020 Balanced Budget Act of 2018 Much Wider Range of Supplemental Benefits – Supplemental benefits are no longer required to be “primarily health related,” opening the door for benefits that address social determinants of health. Benefits May Be Tailored to the Needs of Each Specific Member – Plans will have the flexibility to offer different supplemental benefits based on the individual needs of each member. Expanded Telehealth Coverage in MA Basic Benefit – Plans will be allowed to waive geographic and originating site restrictions that apply in traditional Medicare, opening the door to a wider array of telehealth offerings. Balanced Budget Act of 2018

Value-Based Payment Reform

Humana Value-Based Care Report 52,000 1,000+ 1.9M Individual Humana MA members … … affiliated with 52,000 primary care physicians… …in more than 1,000 value-based agreements across 43 states *2017 Humana Value-Based Care Report available at http://valuebasedcare.humana.com/vbc-report/

Integrated, Value-Based Care Results in Improved Quality and Lower Costs

Questions?