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CMS Expanding HCBS Benefit in Medicare Advantage

The Centers for Medicare and Medicaid Services (CMS) announced on Feb. 1st that it will be expanding the Home and Community Based Services (HCBS) benefit in Medicare Advantage plans. It proposes to increase flexibility by redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports, portable wheelchair ramps, and other assistive devices and modifications when patients need them.

CMS had previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”

The proposed updates will result in a payment increase that promotes stability and ensures that resources will be available to support beneficiaries enrolled in private Medicare plans. LeadingAge NY is encouraged by the flexibility CMS is offering. The new benefits may indicate more changes to come as Medicare Advantage continues to grow and CMS recognizes the value of providers and services.

For a fact sheet on the 2019 Advance Notice, Part II, and the Draft Call Letter, please click here. CMS released Part I of the Advance Notice on Dec. 27, 2017.

The 2019 Advance Notices (Part I and Part II) and Draft Call Letter may be viewed by clicking here and selecting “2019 Advance Notices.” Comments on the proposed Advance Notices and Draft Call Letter are invited from industry, seniors, consumer advocates, and the public and must be submitted by March 5, 2018. The 2019 Final Rate Announcement and Call Letter will be published on Mon., April 2, 2018.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871