CMS updates Medicare Advantage coverage to include social, environmental contributors
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CMS updates Medicare Advantage coverage to include social, environmental contributors

The Centers for Medicare & Medicaid Services (CMS) recently announced updates to what is covered under Medicare Advantage plans, with a specific focus on addressing social and environmental health factors and increasing competition among plans.

The major change announced involves increasing coverage and flexibility to better tailor benefits to patients’ needs—especially those with chronic conditions. While in previous years Medicare Advantage plans only covered services that directly prevented or treated a patient’s condition, it is now beginning to expand coverage to address social and environmental factors that may have a direct impact on one’s health. For example, an updated plan could now cover home air filters or carpet shampooing for patients with asthma, or a grocery delivery service providing produce and other heart-healthy food to patients with heart conditions.

Other key updates included in the agency’s announcement:

  • Part D plans will be encouraged to offer a minimum of one opioid-reversal agent on a lower cost-sharing tier
  • Medicare Advantage plans will receive a 2.53 percent pay increase in 2020, down from the 3.4 percent increase they saw in 2019
  • The plans’ payments will be determined by a larger percentage of patient “encounter data,” which insurers had opposed

In recent years, these private plans have increased to account for 13 percent of skilled nursing facilities’ (SNFs) revenue, as noted by the National Investment Center for Seniors Housing & Care. Read CMS’ full announcement about the updates.

For more information on this topic, or to learn how Baker Tilly healthcare specialists can help, contact our team.

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