There is a general lack of financial resources, beyond the Medicaid program, to help individuals with complex care needs afford non-medical services and supports to remain independent in their homes and communities and avoid expensive hospital admissions and/or institutionalization. A promising start to covering this type of care through Medicare was enacted in the Bipartisan Budget Act of 2018, as part of the CHRONIC Care Act. This provision allows Medicare Advantage (MA) plans greater flexibility in structuring and targeting supplemental benefits, so that plans could offer benefits to “maintain the health or function of chronically ill enrollees” that are not “primarily health-related.” LTQA is committed to ensuring that this law is implemented in a manner that improves healthcare for beneficiaries.
Publications:
- Medicare Advantage’s New Supplemental Benefit: Plan Views and Responses
- Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill
Working Materials and Related Resources:
- P&T Community: Employer-Provider Interface Council (EPIC) 2019: Managing Health Benefits In The Era Of Change
- AIS Health: Working Group Recommends New SSBCI Be Clear, Equitable
- FierceHealthcare: Why supplemental benefits in MA mark a ‘turning point’ for Medicare policy
- McKnight’s Senior Living: Providers should be ‘actively involved’ as some Medicare beneficiaries begin receiving nonmedical benefits, experts say
- n4a Aging and Disability Business Institute Blog: 2020 Final Call Letter Offers Guidance and Structure for Medicare Advantage Supplemental Benefits
- Better Care Playbook: Expanded Flexibility in Medicare Advantage Supplemental Benefits