The Centers for Medicare & Medicaid Services announced Monday that it has finalized updates to what private Medicare plans cover, including everything from air quality devices to food.
Federal officials said their hope is to better address social determinants of health for older adults while also spurring greater competition among increasingly popular private policies. Starting in 2019, MA plans will offer supplemental benefits not currently covered by Medicare Parts A and B, if those benefits help to compensate for physical impairments, diminish the impact of injuries, or reduce avoidable trips to the emergency room, according to an announcement.
Such privately administered plans are of growing interest to the field, accounting for 13% of SNFs’ revenues, according to the National Investment Center for Seniors Housing & Care. However, experts said these changes will not affect payment for nursing facilities and other Medicare providers.
“With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that focus on preventing disease and keeping people healthy,” CMS Administrator Seema Verma said.
In 2020, chronically ill patients with MA plans will be able to access a broader range of supplemental benefits that are not directly related to healthcare. For example, those could include additional meal delivery options, transportation to buy groceries, or home air cleaners and carpet shampooing for a patient with asthma.
While the policy updates will not impact SNF pay rates, they will have broader implications for the field, said Erin Shvetzoff Hennessey, CEO of consulting firm Health Dimensions Group. Making the decision to utilize skilled care is not always based on medical considerations alone, she said, and HDG has urged its SNF clients to offer some of these services in their communities, including transportation and in-home care.
“Changes like these again remind us as SNF operators that our payer partnerships, service offerings and diversification will be key to our success as the way our country delivers care to seniors rapidly changes,” she told McKnight’s.
CMS’ announcement also included a 2.53% pay increase in 2020 for Medicare Advantage plans. Payments will now be calculated based on a high percentage of patient encounter data, a switch that insurers have opposed, according to Modern Healthcare.
