A Closer Look at 2019 MA Plans' HCBS Supplemental Benefits

Center for Managed Care | December 13, 2018 | by Nicole Fallon

Two reports released in recent weeks from the Long-Term Quality Alliance (LTQA) and the Better Medicare Aliance (BMA) shed more light on how Medicare Advantage Organizations (MAOs) evaluated offering the new benefits for CY2019 Medicare Advantage plans, which plans opted to offer the benefits the benefits offered and state where available. The conclusion few plans --only 102 -- are testing the new benefits in CY2019, more are looking to offer some new HCBS benefit in CY2020 but challenges remain.

The first report issued by the Long-Term Quality Alliance (LTQA) summarizes findings from interviews with seven Medicare Advantage organizations discussing how they approached the issue of whether or not to take advantage of the newly available HCBS supplemental benefits.The report notes that while the plans are enthusiastic about including these benefits that some key barriers remain to achieving that goal. For 2019, many plans did not have enough time to fully evaluate the opportunity and include the new services since the CMS guidance was released in late April and final bids were due in early June.  One of the key concerns that should also be a consideration for HCBS providers is that it is difficult for plans to be able to ensure they are able to consistently offer the same supplemental benefits from year to year.  For consumers, that can be frustrating to not be able to rely on the HCBS benefits being offered every year, forcing them to shop for a new MA plan annually.  For providers, the lack of predictability in these supplemental benefit offerings could pose a financial threat from year to year.  Some of the other challenges the plans identified with the new benefit include: potential adverse selection, actuarial ability to estimate savings related to the benefit offerings, and identfying and establishing contracts with non-Medicare providers.  Therefore, the plans will be seeking evidence of the benefit and particularly any cost savings of any supplemental HCBS services they offer and an easy way to identify quality providers to deliver any identified services.

According to a second report commissioned by the Better Medicare Alliance and conducted by Milliman, while there will be roughly 3700 Medicare Advantage plans available around the country in CY2019, just 102 of them have included any of the new HCBS services as a supplemental benefit. This number is less than half of the number announced by CMS originally because its number also included plans taking advantage of new flexibility around plan uniformity requirements. The new service offerings being tested by the limited group of plans in CY2019 fall into three main categories:

  • Home-based Palliative Care:  29 plans in 5 states (MN, NY, OR, PA, WA)
  • In-home Support Services: 51 plans in 15 states (CA, FL, GA, HI, IL, KY, MD, NJ, NY, OK, PA, RI, SC, TX, VA)
  • Medically-Approved Non-Opioid Pain Management: 22 plans in 5 states (FL, ME, MA, NH, NM)

The report lists the specific plans by state under each of the benefit they are offering. Of note, no Medicare Advantage plans are offering an adult day services supplemental benefit in their CY2019.