In February, President Donald Trump signed the Bipartisan Budget Act of 2018 (BBA 2018) into law. The law seeks to lower Medicare costs and improve care quality by offering members supplemental benefits that can assist with day-to-day activities. What does this mean for health plans?
The Bipartisan Budget Act of 2018
The law, weighing in at 250 pages, expands supplemental benefits to meet the needs of chronically ill Medicare Advantage (MA) plan members in 2020. In the Bipartisan Budget Act 2018, supplemental benefits are defined as having “a reasonable expectation of improving or maintaining the health or overall function of the chronically ill member and may not be limited to being primarily health related benefits.” These could include non-skilled home care services, such as dressing, bathing, and transportation. This is an incredible opportunity for health plans to use in-home support to bridge healthcare’s final mile. This re-imagining of healthcare will keep seniors healthier and empower payers to reduce unnecessary utilization and readmissions.
BBA 2018 Allows Benefit Customization for Medicare Advantage Plans
Current law requires MA plans to provide uniform benefits to all members in a specific plan. This means an insurer must offer an MA member in Tennessee enrolled in a health maintenance organization (HMO) plan the same benefits as someone in California in an HMO MA plan, regardless of health status, age or location. The Bipartisan Budget Act 2018 allows the Department of Health and Human Services Secretary the ability to waive the uniformity requirement if deemed appropriate. This would allow payers to offer individualized support. This means the Medicare Advantage plan member in Tennessee may be sicker and live in a rural area, thereby needing different benefits than the healthier HMO MA member in California. More flexibility would allow payers to offer supplemental benefits that meet these individual members’ health needs. The law was enhanced by an April final rule from CMS which allows MA plans to offer supplemental benefits to MA members in 2019. Plans also have the ability to tailor such services to meet the unique needs of patients, such as rides to doctor appointments. The loosening of such regulations is meant to enable plans to focus on the social determinants of health in order to improve quality of care while keeping chronically-ill patients out of the ER and hospitals.
Why These Changes Matter for Home Care
Regarding the Bipartisan Budget Act 2018, the Bipartisan Policy Center in August wrote that “this new flexibility for health plans has significant potential to provide access to non-medical health-related benefits, including those that have proved successful in keeping patients in their homes.” The possibilities of how the Bipartisan Budget Act's 2018’s changes could impact supplemental benefits are exciting. CareLinx has been a long-time advocate for the advantages of services that extend into the home, and it seems that the industry is finally shifting its views to match. Expanding new supplemental benefits in insurance plans could usher in a new model for care delivery. As the American population continues to age, CMS expects overall healthcare spending to increase and is looking to bend the cost curve. Supplemental benefits targeting the social determinants of health are a hopeful means to that end. They can improve care at a lower cost. A new era of home care and patient management is just beginning, get ahead of the competition.