Medicare Advantage Managers Give 2020 LTC Sample Details

Medicare Advantage plans can put permanent wheelchair ramps in enrollees’ homes in 2020, or even widen enrollees’ hallways to accommodate wheelchairs, if they choose to do so.

Officials at the Centers for Medicare and Medicaid Services (CMS) have included that change in the final rules for Special Supplemental Benefits for the Chronically Ill, or SSBCI.

CMS put the final SSBCI rules in the final bidder package for the Medicare Advantage and Medicare Part D prescription drug plans, which came out today.

The final package appears to suggest that Medicare Advantage plan issuers can offer samples of two types of long-term care (LTC) type benefits in 2020: the kinds of health-related health maintenance benefits that issuers could offer, and the new SSBCI benefits.

The final package also makes it clear that, from the perspective of CMS officials, “SSBCI” is a plural word.

A Little Bit of Post-Acute Care Coverage

Traditionally, Medicaid has paid for nursing home care for the poor.

Medicare has paid only for health care, not for non-medical support services.

In 2019, CMS officials wiggled that boundary by announcing, after most issuers had already started developing their 2019 bid proposals, that issuers could cover “primarily health-related” benefits meant to address the “social determinants of care.” In practice, a few issuers have used that flexibility to do things like giving caregivers access to a caregiver support line, or providing patients who had just come out of the hospital with a few days of coverage for adult medical day care services.

The Medicare Advantage social determinants of care benefits available this year are more like samples of the kinds of benefits available from convalescent care insurance policies, or short-term care insurance policies, than like full-blown long-term care insurance.

For 2020, the new SSBCI rules appear to be encouraging issuers to offer richer support benefits aimed patients with serious chronic conditions who require intensive care coordination and have a high risk of hospitalization or other bad health outcomes.

The list of conditions that could make a patient eligible for SSBCI benefits includes relatively common disorders, such as dementia, rheumatoid arthritis and diabetes, as well as conditions such as kidney failure, liver failure and metastatic cancer.

For those patients, SSBCI benefits could cover items and services such as “meals furnished to the enrollee beyond a limited basis, transportation for non-medical need, indoor air quality equipment and services, and benefits to address social needs,” according to the final call letter.

In the draft version of the call letter posted in January, officials said they would not let issuers cover installation of permanent wheelchair ramps or other improvements that could add to the resale value of a patient’s home.

“However, after reviewing comments, we do not believe such a limit is necessary to implement the statute and permit [Medicare Advantage] plans to offer SSBCI,” officials write in the final call letter.

Meals on Wheels

The new final call letter could be good for revenue for Meals on Wheels and other existing community-based organizations that serve the elderly.

A Medicare Advantage plan issuer must spend something on an SSBCI to count it as an SSBCI, and it can pay an existing community-based organization to provide the SSBCI, according to the final call letter.

Medicare Plan Bidding Basics

The Medicare Part C Medicare Advantage program gives insurers the ability to sell plans that serve as an alternative to traditional Medicare A hospitalization coverage and Medicare Part B physician and outpatient services coverage.

Another related program, the Medicare Part D prescription drug program, gives insurers the ability to sell prescription drug coverage to Medicare enrollees.

About 22 million people have Medicare Advantage plan coverage, and about 21 million have stand-alone Medicare Part D prescription drug plan coverage, according to the CMS data.

The new “final call letter,” and a draft version that came out in January, are part of an elaborate bidding process.

Although CMS calls the new document a “final call letter,” the true final terms will depend partly on insurers’ reaction to the bidding process.

2020 Medicare Advantage Bidding Parameters

In the new rate announcement and final call letter, CMS officials say they expect Medicare program payments to 2020 Medicare Advantage plan issuers to increase an average of 2.53% over 2019 levels.

A year ago, CMS predicted that the 2019 revenue increase would be 3.4%.

Officials are predicting the “effective growth rate,” or increase in the underlying cost of care, will rise to 5.62% in 2020.

A year ago, CMS predicted that the 2019 effective growth rate would be 5.28%.

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