Medicare Advantage Flexibility: Improving Care for Seriously Ill Beneficiaries

Brief
Key Questions Answered
  • How has the Medicare Advantage (MA) program recently changed?
  • What are the two new “key reinterpretations” of MA?
  • What are the benefit changes?
  • What steps should plans take to move forward?
Key Themes and Takeaways

This resource describes recent changes in Medicare Advantage (MA) and their implications for plans.

  • The Centers for Medicare and Medicaid Services (CMS) has recently reinterpreted several key aspects of the MA program, and Congress also passed the CHRONIC Care Act, which expands MA flexibility. 
  • There are two “key reinterpretations”: Redefining supplemental benefits (MA plans may now offer supplemental benefits such as in-home support services and home-based palliative care); and redefining the “uniformity” requirement (plans may vary benefits and cost-sharing according to the different needs of subsets of enrollees). 
  • Plans considering new coverage options should consider changes such as making advance care planning conversations exempt from cost sharing for all enrollees; and strengthening case management services.
  • The following three considerations are essential preparatory steps: plans must evaluate network adequacy for specialty and home-based palliative care; establish credentialing standards that include competency in palliative care; and map out the benefits and the risks of formalizing new structured benefits. 
Authors
Allison Silvers
Torrie Fields
Anna Kytonen
Diane E. Meier
Population Addressed
People with Advanced Illness
Level of Evidence
Expert Opinion
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