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.
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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?
Level of Evidence
Expert OpinionWhat does this mean?