Malnutrition and poor nutrition among the Medicare population can lead to devastating health outcomes, higher utilization, and increased costs, particularly among members with chronic conditions. The rising cost of caring for these members is a growing concern for many health plans. Indeed, much of the growth in spending for Medicare beneficiaries is because of conditions such as diabetes, arthritis, hypertension, and kidney disease.[i]
These issues are addressed in the Medicare Advantage and Part D Call Letter, released by the Centers for Medicare & Medicaid Services (CMS) on Monday, which allows Medicare Advantage plans to include home-delivered meals and other supportive services in their benefits for Plan Year 2020. With these benefits, CMS intends to help plans better tailor benefit offerings, address gaps in care, and improve health outcomes for the chronically ill population.
Home-delivered meals and other services may be included in 2020 plans as part of Special Supplemental Benefits for the Chronically Ill (SSBCI). According to the guidance, MA plans can now offer these services to chronically ill enrollees if they have a “reasonable expectation of improving or maintaining the health or overall function of an individual as it relates to their chronic condition or illness and may not be limited to being primarily health related benefits.”
In order to qualify for the benefits, an enrollee must:
- Meet CMS’ criteria for “chronically ill,” which they define as any enrollee with a condition listed in Section 20.2 of Chapter 16b of the Medicare Managed Care Manual. CMS notes in the guidance that 73% of current Medicare enrollees have at least one of these conditions, which include diabetes, cardiovascular disorders, congestive heart failure, stroke, chronic lung disorders, chronic and disabling mental health disorders, and others.
- Be at high risk for hospitalization or other adverse health outcomes
- Need intensive care coordination.
CMS allows plans the flexibility to develop internal criteria to determine if enrollees meet these criteria.
Through work with over 500 organizations across the country, including Medicare and Medicaid plans, Mom’s Meals has unparalleled insight into the optimal approach to leveraging nutrition solutions to improve health. For information about best practices, or to engage the experts at Mom’s Meals in helping construct your 2020 Bid submission, please contact John.Phillips@MomsMeals.com or 1-888-343-8020.