‘Rare Flexibility’ for Medicare Advantage Plans Could Lead to Home Care Inflection Point

The Centers for Medicare & Medicaid Services (CMS) has granted further flexibility to Medicare Advantage (MA) plans to offer more benefits to beneficiaries during the COVID-19 crisis. For home care providers, that could mean more business opportunity.

The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was announced in 2019 for the 2020 plan year. Broadly, it allows MA plans to offer services such as non-medical transportation, meal support, home modification and other “general supports for living” to certain populations.

As of March, there were at least 245 plans offering one or more of the SSBCI options, according to Washington, D.C.-based research and advisory services firm ATI Advisory. But that number could increase now, as CMS has offered rare flexibility to plans to increase their benefit packages mid-year.


That change creates a massive opportunity for plans to extend critical services to MA beneficiaries during the public health emergency, according to ATI Advisory.

“This is an issue that we are very interested in,” Tyler Cromer, principal at ATI Advisory, told Home Health Care News. “Because we really do view it as a turning point — and as an opportunity, really — to provide some new types of benefits to Medicare beneficiaries that plans have never been able to provide before.”

Benefits offered under SSBCI, created in a pre-COVID-19 reality, are especially relevant now. They allow beneficiaries to receive proper food and produce while ensuring their social needs are met.


Both points are more important under stay-at-home orders and with a more risk-filled outside world for the senior population.

Plans should leverage the mid-year benefit flexibility to meet members’ evolving needs and also partner with local community-based organizations to identify gaps in services, the ATI report suggests.

“It’s [about] the extent to which the plans take [advantage of] this flexibility, but I think they will,” Cromer said.

For home care agencies such as Right at Home and FirstLight Home Care, which have already partnered with MA plans to deliver these non-health related benefits, more plans offering non-medical supplemental benefits would allow them to further capitalize off of their MA strategies.

For other providers who have not yet waded into MA waters, it gives them a chance to do so, and could help make up for some lost revenue caused by the COVID-19 outbreak.

“We’ve always been hopeful that plans would be willing to offer these benefits,” Elexa Rallos, an analyst at ATI Advisory, told HHCN. “[The report] really underscores the importance of providing these types of social supports in the home. We heard a lot about food, produce and groceries — these are the vital services that Medicare beneficiaries need during these times. I think this will really be an inflection point.”

Given that there’s been an increasing number of patients either unable or unwilling to receive health care services due to the risk of COVID-19 infection, plans could have additional bandwidth to provide SSBCIs to their members.

“Because medical claims are likely to come in lower than they [plans] were anticipating, they will have the flexibility,” Cromer said. “And we think this is the right thing to do to provide services that support people’s health and their ability to stay healthy during the pandemic.”

The population that is at-risk when it comes to the COVID-19 crisis is generally synonymous with the group of people that qualify for SSBCIs.

If CMS is willing to expand the group of beneficiaries who qualify for SSBCIs, that could mean even more chances for home care partnerships with plans across the country.

The ATI Advisory report urged CMS to provide additional flexibility in determining who can receive these benefits, to further allow benefits to address social connectivity and to provide more clarity on how helpful these benefits can be during the COVID-19 outbreak.

A promising number of areas across the country are at least offering — or planning to offer — some sort of non-medical supplemental benefits, according to the report.

In regards to one of the SSBCIs — social needs benefits — MA plans have been authorized by CMS to provide tablets or smartphones to beneficiaries so they are better able to avoid social isolation.

That could be another avenue for providers to increase their involvement, but CMS has not yet allowed home care providers to be reimbursed for telehealth visits.

“I am really struck by what an opportunity this is … to provide services and benefits that people really need right now to stay safe in their homes,” Cromer said. “Two years ago, this flexibility would not have existed. None of us want to be in the situation we’re in right now. But the tools do exist to provide support and services that will help Medicare beneficiaries stay healthy. I think that’s really exciting.”

The brief by ATI Advisory was done in tandem with the Long-Term Quality Alliance, with additional support from The SCAN Foundation.

“Social supports are paramount for people with complex care needs to remain safely in their homes,” Bruce Chernof, CEO of The SCAN Foundation, said in a statement. “Medicare Advantage plans should ensure these non-medical services are included in benefit designs — and if not, take advantage of the unprecedented CMS flexibility to add them.”

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