BMA Asks CMS to Enhance, Solidify Medicare Advantage Benefits

Better Medicare Alliance (BMA) has penned a letter to CMS detailing a number of Medicare Advantage policy recommendations regarding Medicare Advantage benefits and care coordination, health equity, and in-home health risk assessments.

The organization sent the letter as CMS prepares its calendar year 2023 Medicare Advantage rate and policy-setting process.

Supplemental benefits are a key feature of Medicare Advantage plans that work to address beneficiaries’ health in a holistic manner and enable care coordination. According to the letter, BMA wants to ensure that this will not change.

The organization has asked CMS to maintain policies that allow Medicare Advantage plans to flexibly design and offer supplement benefits to beneficiaries. According to BMA, this flexibility allows plans to target specific issues through tailored benefits.

Additionally, many supplemental benefits prioritize non-medical needs including food, transportation, and support at home. These benefits may also help health plans address substance use disorder, as they can offer telehealth services, counseling, and transportation to treatment appointments.

BMA also wants to make it easier for beneficiaries to access and understand information about supplemental benefits. The organization recommended that CMS standardize the format and language of the Medicare Plan Finder to include clearer information and better comparison tools for supplemental benefit offerings.

CMS should also disclose additional information about supplemental benefits on the Medicare Plan Finder, which will highlight all Medicare Advantage benefits, the letter stated.

BMA suggested that CMS increase opportunities under the value-based insurance design (V-BID) model to allow Employer Group Waiver Plans to participate. Promoting transparency, reducing eligibility confusion, and widening the adoption of supplemental benefits that address social determinants of health could help reduce health disparities, BMA said in the letter.

Supplemental benefits help Medicare Advantage plans to address and advance health equity, and BMA has offered several recommendations for CMS that facilitate this goal.

The organization has asked CMS to standardize the process of race, ethnicity, gender, and social determinants of health data collection. This will ensure data consistency and allow health plans to better address food insecurity, housing instability, and financial insecurity, BMA said.

Similarly, BMA suggested that CMS make health outcomes data available to health plans, researchers, and the public to encourage best practices.

The letter also recommended that CMS adopt quality measures that account for social risk factors so beneficiaries can report whether their social needs are being addressed properly. Promoting and incentivizing the use of Z codes, which identify social determinants of health issues, may also help identify beneficiaries who could use non-medical services, according to BMA.

Finally, BMA offered recommendations about in-home health risk assessments.

Medicare Advantage plans offer in-home clinical visits that help provide primary care services to beneficiaries.

BMA asked CMS to codify in-home health risk assessment best practices to ensure high-quality visits.

Some best practices stated in the letter include:

• Have physicians, or qualified nonphysician practitioners—specifically advanced practice registered nurses, nurse practitioners, physician assistants or certified clinical nurse specialists—perform in-home clinical assessments 
• Assist with scheduling appointments with appropriate providers and making referrals and/or connections for the beneficiary to appropriate community resources 
• Conduct an environmental scan of the beneficiary’s home for safety risks and need for adaptive equipment  
• Establish a process to verify that information obtained during the assessment is provided to the appropriate plan provider(s) 

The organization also asked that CMS establish guidelines for follow-up care after in-home health risk assessments to better coordinate the beneficiary’s care.

In line with BMA’s social determinants of health-focused suggestions, the organization recommended that the agency include screening for social risk factors during in-home health risk assessments to help beneficiaries receive the holistic care that they need.

These recommendations were backed by Better Medicare Alliance’s over 170 ally organizations and more than 600,000 grassroots advocates.