BMA in the News

House Lawmakers Tout MA Supplemental Benefits; Push CMS To Do More

More than 300 House lawmakers touted supplemental benefits for the chronically ill in Medicare Advantage as part of an annual letter praising the program, and they also urged CMS to do as much as possible to build on the broader category of supplemental benefits the agency authorized last year. At the same time, the lawmakers asked CMS to give MA plans enough time to evaluate and put into place substantive changes to the program. The letter, released on Wednesday (Feb. 6) in a bipartisan effort spearheaded by Reps. Tony Cárdenas (D-CA) and Brett Guthrie (R-KY), Earl Blumenauer (D-OR) and Mike Kelly (R-PA), followed the release of the 2020 draft MA and Part D rate notice and call letter. As part of the letter, CMS laid out guidance on new supplemental benefits for chronically ill enrollees that plans can offer in 2020. Lawmakers directed the agency to offer those benefits through the Bipartisan Budget Act of 2018, and in the letter they praised the law for offering benefits to 1.5 million beneficiaries. CMS said benefits for the chronically ill might include transportation for non-medical needs, home-delivered meals, food and produce. James Michel, the Better Medicare Alliance policy director, said on a press call that CMS is proposing to give plans broad discretion under the draft call letter to define new benefits, and the organization is excited about it. Michel pointed out, however, there would be no additional funding provided to plans for those benefits. "Plans will probably have to be very thoughtful about how they offer these new benefits in 2020 in the absence of new funding,” Michel said. He predicted that plans will exercise caution in the early years of the expansion as they gain experience on what works and what doesn’t. "They don't get extra dollars for this, so this is a little bit of work to figure out which benefits they can provide with the limited supplemental dollars that they have available,” said Allyson Schwartz, CEO and president of BMA. Both BMA and America’s Health Insurance Plans applauded the lawmakers’ letter to CMS. BMA said it is particularly interested in the ability for plans to further manage chronic disease by addressing social determinants of health “with improved telehealth, nutrition, transportation services.” Casey Schwarz, senior counsel in federal policy with Medicare Rights Center, told Inside Health Policy that flexible supplemental benefits need oversight. Schwarz said oversight must be done not just by plans, but by the federal government through data collection and audits. The House lawmakers ask CMS to “ensure that any substantive changes to the Medicare Advantage program provide plan sponsors with sufficient time for thorough evaluation and implementation.” MRC agrees with Congress that CMS should give MA plans enough time to evaluate and implement program changes. Schwarz also said MRC is encouraging CMS to expand traditional Medicare at the same rate it is expanding MA. New expanded supplemental benefits and flexibilities have been allowed in MA through the 2019 and 2020 call letters. Schwarz said MRC wants to see how those supplemental benefits play out before adding more flexibility. The House lawmakers, however, ask CMS to “build on the enhanced supplemental benefits that were offered this plan year by providing additional flexibility to help drive the next generation of innovative approaches in Medicare to improve health outcomes, while also maintaining robust beneficiary protections.” Inside Health Policy reached out to the offices of Guthrie, Cárdenas, Blumenauer and Kelly to ask what additional flexibilities for enhanced supplemental benefits might look like, but did not hear back by time of publication. The Center for Medicare Advocacy (CMA) agreed with the Medicare Rights Center, and said in a statement that policymakers should “advance complete equity between MA and traditional Medicare, including both the scope of services provided and programmatic spending,” instead of continuing to favor MA. It added that “wasteful spending on MA should be reinvested into the Medicare program to the benefit of all enrollees, not just those who choose to enroll in private plans.” BMA’s Schwartz, however, said that lessons learned from supplemental benefits could benefit traditional Medicare in the long run, as well as MA. Michel said different categories of supplemental benefits set up by CMS offer a series of increasing flexibility for plans. CMS first offered plans the option to provide supplemental benefits for some beneficiaries last year and added to that flexibility with more options plans can provide to the chronically ill. The Value-Based Insurance Design program offers a third category of supplemental benefits that gives plans an even wider range of options that those offered under the call letters. Schwarz told IHP that beneficiaries might be confused about which benefits they are entitled to and warned this might create an opportunity for Medicare fraud, with people attempting to sell additional programs not covered under any plan. -- Chelsea Cirruzzo (ccirruzzo@iwpnews.com)