Two very big moves in Medicare you may have missed

While Medicaid and the commercial market under the ACA continue to create differing policy views based on a partisan outlook, Medicare continues to drive innovation in meaningful ways that garners bi-partisan support.

One way that is happening is through the recent Bi-Partisan Budget Act that passed Congress on March 23rd, 2018.  If you like reading 250 page legislation, skip to page 138.  Alternatively, you can look up Section 50322(a)(2)(D) under Title III(C).

‘‘(i) IN GENERAL.—For plan year 2020 and subsequent plan years, in addition to any supplemental health care benefits otherwise provided under this paragraph, an MA (Medicare Advantage) plan, including a specialized MA plan for special needs individuals (as defined in section 1859(b)(6)), may provide supplemental benefits described in clause (ii) to a chronically ill enrollee (as defined in clause (iii)).

‘‘(ii) SUPPLEMENTAL BENEFITS DESCRIBED.— ‘‘(I) IN GENERAL.—Supplemental benefits described in this clause are supplemental benefits that, with respect to a chronically ill enrollee, have
a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.

The emphasis there is mine.

Here’s what this clause means:  starting in 2020, Medicare Advantage carriers can build into their supplemental plans benefits, programs, and supports that support health but which are not considered traditional health care.  In other words, anything related to the social determinants like housing, nutrition, etc. can now be included as a covered benefit.  That means providers who might normally provide traditional health care services can now get paid by their MA plan partner for services that extend beyond “primarily health related benefits.”

This is a really big deal.

Addressing social determinants, or non-health care matters that support health, is in many ways the new frontier of health care.  Many states have talked about doing this in their Medicaid programs, but have had significant difficulty in getting that flexibility from CMS.

Here, Congress is now directing CMS to do this for Medicare.  Over time, this will trickle down to Medicaid and the commercial space, too, I would expect. CMS is already starting the rule writing work to support this, and finalized rules in April that add flexibility to Medicare.

The second big item Medicare pushed out recently, and which many may have missed, is a requirement that hospitals post their prices for patients to see.

According to a release from CMS last week, this is an incremental step but a relatively important one nonetheless and certainly not the last the agency foresees taking.

While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.

Seema Verma, Administrator at CMS, reinforced the goal of the Trump Administration when it comes to moving health care forward.

We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes. Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it.

While there has been much gnashing of teeth about the ACA in Congress, these are two concrete examples of how Medicare policy is getting reshaped to move the system forward in meaningful ways.