2020 SSBCI and New Primarily Health-Related Benefits€¦ · Rifkin Managed Care Holding Company,...
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2020 SSBCI and New Primarily Health-Related Benefits March 20, 2020
Transcript of 2020 SSBCI and New Primarily Health-Related Benefits€¦ · Rifkin Managed Care Holding Company,...
2020 SSBCI and New Primarily Health-Related BenefitsMarch 20, 2020
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Plans Offering Special Supplemental Benefits for the Chronically Ill (SSBCI)Number of Plans Offering SSBCI
in 2019:Number of Plans Offering SSBCI
in 2020:Number of Plans Offering SSBCI
in 2021:
0 245*Will be available between January-March of 2021
Number of Beneficiaries in these plans: 1,694,8921
Number of Counties: 1,152 (including Puerto Rico and states not displayed in map)
Map of Counties where Plans Offer SSBCI
Source: ATI Advisory analysis of CMS PBP files, includes D-SNPs, excludes Prescription Drug Plans (PDPs) and PACE. 1. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
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Plans Offering New Primarily Health-Related Supplemental BenefitsNumber of Plans Offering New
Supplemental Benefits in 20191:Number of Plans Offering New
Supplemental Benefits in 20201:Number of Plans Offering New Supplemental Benefits in 2021:
102 364 (512 including D-SNPs2) *Will be available in October of 2020
Source: 1. Milliman’s “Review of Contract Year 2020 Medicare Advantage supplemental healthcare benefit offerings” brief, excludes D-SNPs. 2. ATI Advisory analysis of CMS PBP files, includes D-SNPs, excludes PDPs and PACE. 3. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.Benefits included: In-home support services, adult day health, home-based palliative care, support for caregivers, therapeutic massage.
Number of Beneficiaries in these plans: 2,654,2453
Number of Counties: 1,819 (including Puerto Rico and states not displayed in map)
Map of Counties Offering New Primarily Health-Related Supplemental Benefits (including D-SNPS)
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Plans Offering SSBCI and/or New Primarily Health-Related Supplemental Benefits
Number of Beneficiaries in these plans: 3,536,569Number of Counties: 1,850 (including Puerto Rico and states not displayed in map)
Source: ATI Advisory analysis of CMS PBP files, includes D-SNPs, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
Number of Plans Offering at Least one SSBCI or New Primarily Health-Related Benefit in 2020:
Number of Plans Offering at Least one SSBCI or New Primarily Health-Related Benefit in 2021:
619*First half will be available in October of 2020 and then January-March of 2021
Map of Counties Offering Either SSBCI or New Primarily Health-Related Supplemental Benefits (including D-SNPS)
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2020 SSBCI and New Primarily Health-Related Benefits
BenefitNumber of Plans Offering in
2020:
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In-Home Support Services 223
Adult Day Health Services 85
Home-Based Palliative Care 61
Support for Caregivers of Enrollees 125
Therapeutic Massage 230TOTAL (offering at least 1 new primarily health-related supplemental benefit):
512
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SS
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Food and Produce 101
Meals (beyond limited basis) 71
Pest Control 118
Transportation for Non-Medical Needs 88
Indoor Air Quality Equipment and Services 52
Social Needs Benefit 34
Complementary Therapies 1
Services Supporting Self-Direction 20
Structural Home Modifications 44
General Supports for Living 67
Other: Service Dog Supports 51
TOTAL (offering at least 1 SSBCI): 245
Total number of plans offering at least 1 SSBCI and/or at least 1 new primarily health-related supplemental benefit: 619
Source: ATI Advisory analysis of CMS PBP files, includes D-SNPs, excludes Prescription Drug Plans (PDPs) and PACE.
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SSBCI
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Listing of Parent Organizations Offering SSBCI In Their Plans
Parent Organization Number of Plans
Alignment Healthcare USA, LLC 6
Anthem 98
Aware Integrated, Inc. 1
Blue Cross and Blue Shield of Kansas City 4
Capital Blue Cross 2
Cigna 8
CVS/Aetna 3
Gateway Health Plan 1
Geisinger Health 44
Guidewell Mutual Holding Corporation 7
Healthfirst, Inc. 1
Health Partners, Inc. 1
Humana 3
InnovaCare Inc. 2
Kalos Health, Inc. 1
Martin's Point Health Care, Inc. 12
Medica Holding Company 8
Medical Card System, Inc. 13
MHNU Corporation 2
Regency ISNP Holdings LLC 1
Rifkin Managed Care Holding Company, LLC 4
SCAN Health Plan 12
Sentara Health Care (SHC) 9
Steward Health Care System, LLC 2
TOTAL NUMBER OF PLANS: 245
*Note: Out of number of parent organization’s plan offerings, excluding PDPs and PACE.Source: ATI Advisory analysis of CMS PBP files.
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Food and Produce
What counts as “Food and Produce?”
“Food and produce to assist chronically ill enrollees in meeting nutritional needs may be covered as SSBCI. Plans may include items such as (but not limited to) produce, frozen foods, and canned goods. Tobacco and alcohol are not permitted.”1
How many plans are offering a Food and Produce benefit in CY 2020?
101 PlansOffering Food and Produce benefits in CY 2020 (75
plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
23 states and Puerto Ricohave plans offering Food and Produce in at least
one county in CY 20202
with 840,207 Medicare Beneficiaries
Enrolled in these 101 Plans in February 20203
Which organizations are offering Food and Produce?✓ Alignment Healthcare USA, LLC✓ Anthem Inc.✓ Capital BlueCross✓ Healthfirst, Inc.✓ Humana Inc.✓ InnovaCare Inc.✓ Kalos Health, Inc.✓ Martin’s Point Health Care, Inc.✓ Medica Holding Company✓ Medical Card System, Inc.✓ MHNU Corporation
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Food and Produce Are Availablein 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
1010
Meals
What counts as “Meals?”
“Meals may be offered beyond a limited basis as a non-primarily health-related benefit to chronically ill enrollees. Meals may be home-delivered and/or offered in a congregate setting.”1
How many plans are offering Meals in CY 2020?
71 PlansOffering Meals in CY 2020 (64 plans excluding D-
SNPs and MMPs)
Where are these benefits being offered?
12 states and Puerto Ricohave plans offering Meals in at least one county in
CY 20202
with 341,093 Medicare Beneficiaries
Enrolled in these 71 Plans in February 20203
Which organizations are offering Meals?
✓ Anthem Inc.✓ Aware Integrated, Inc.✓ CVS Health Corporation ✓ Gateway Health Plan, LP✓ Geisinger Health✓ Guidewell Mutual Holding Corporation✓ Humana Inc.✓ InnovaCare Inc.✓ Martin’s Point Health Care, Inc.
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Meals Are Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Pest Control
What counts as “Pest Control?”
“Pest eradication services that are necessary to ensure the health, welfare, and safety of the chronically ill enrollee. Services may include pest control treatment(s) or products that may assist the enrollee in the pest eradication (e.g., traps, pest control sprays, cleaning supplies).”1
How many plans are offering Pest Control Services in CY 2020?
118 PlansOffering Pest Control Services in CY 2020 (98 plans
excluding D-SNPs and MMPs)
Where are these benefits being offered?
18 stateshave plans offering Pest Control in at least one
county in CY 20202
with 1,070,722 Medicare Beneficiaries
Enrolled in these 118 Plans in February 20203
Which organizations are offering Pest Control?
✓ Anthem Inc.✓ Geisinger Health✓ Humana Inc.
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Pest Control Is Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Transportation for Non-Medical Needs
What counts as “Transportation for Non-Medical Needs?”
“Transportation to obtain non-medical items andservices, such as for grocery shopping, banking, and transportation related to any other SSBCI, is a non-primarily health-related benefit. Such transportation may be reimbursed, arranged, or directly provided by an MA plan as a SSBCI.”1
How many plans are offering Non-Medical Transportation in CY 2020?
88 PlansOffering Non-Medical Transportation in CY 2020 (72
plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
11 states and Puerto Ricohave plans offering Non-Medical Transportation in at
least one county in CY 20202
with 743,642 Medicare Beneficiaries
Enrolled in these 88 Plans in February 20203
Which organizations are offering Non-Medical Transportation?✓ Cigna✓ Gateway Health Plan, LP✓ Geisinger Health✓ Humana Inc.✓ Kalos Health, Inc.✓ Medical Card System, Inc.✓ Regency ISNP Holdings LC✓ Rifkin Managed Care Holding Company, LLC✓ SCAN Health Plan✓ Sentara Health Care✓ Steward Health Care System, LLC
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Non-Medical Transportation Is Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Indoor Air Quality Equipment and Services
What are “Indoor Air Quality Equipment and Services?”
“Equipment and services to improve indoorair quality, such as temporary or portable air conditioning units, humidifiers, dehumidifiers, High Efficiency Particulate Air filters, and carpet cleaning may be covered as SSBCI. Plans may also include installation and servicing of equipment as part of the benefit.”1
How many plans are offering Indoor Air Quality Equipment and Services in CY 2020?
52 PlansOffering Indoor Air Quality Equipment and Services in CY 2020 (50 plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
3 stateshave plans offering Indoor Air Quality Equipment and Services in at least one county in CY 20202
with 615,697 Medicare Beneficiaries
Enrolled in these 52 Plans in February 20203
Which organizations are offering Indoor Air Quality Equipment and Services?
✓ Cigna✓ Gateway Health Plan, LP✓ Geisinger Health✓ Humana Inc.
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Indoor Air Quality Equipment and Services Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Social Needs Benefit
What is a “Social Needs Benefit?”
“Access to community or plan-sponsored programs and events to address enrollee social needs, such as non-fitness club memberships, community or social clubs, park passes, and access to companion care, marital counseling, family counseling, classes for enrollees with primary caregiving responsibilities for a child, or programs or events to address enrollee isolation and improve emotional and/or cognitive function, are non-primarily health-related benefits that may be covered as SSBCI.”1
How many plans are offering a Social Needs Benefit in CY 2020?
34 PlansOffering Social Needs Benefits in CY 2020 (28 plans
excluding D-SNPs and MMPs)
Where are these benefits being offered?
15 stateshave plans offering a Social Needs Benefit in at
least one county in CY 20202
with 214,188 Medicare Beneficiaries
Enrolled in these 34 Plans in February 20203
Which organizations are offering a Social Needs Benefit?
✓ Alignment Healthcare USA, LLC✓ Blue Cross and Blue Shield of Kansas City✓ CVS Health Corporation✓ Health Partners, Inc.✓ Humana Inc.✓ Martin’s Point Health Care, Inc.✓ Regency ISNP Holdings LLC✓ Rifkin Managed Care Holding Company, LLC✓ Steward Health Care System, LLC
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where a Social Needs Benefit Is Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
2020
Complementary Therapies
What are “Complementary Therapies?”
“Complementary therapies offered alongside traditional medical treatment may be offered as non-primarily health-related SSBCI. Complementary therapies must be provided by practitioners who are licensed or certified, as applicable, in the state in which they practice and are furnishing services within the scope of practice defined by their licensing or certifying state.”1
How many plans are offering Complementary Therapies in CY 2020?
1 PlanOffering Complementary Therapies in CY 2020 (1
plan excluding D-SNPs and MMPs)
Where are these benefits being offered?
South Carolinahas a plan offering Complementary Therapies in at
least one county in CY 20202
with 37,245 Medicare Beneficiaries
Enrolled in this 1 Plan in February 20203
Which organizations are offering Complementary Therapies?
✓ Humana Inc.
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
2121
Counties Where a Complementary Therapies Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Services Supporting Self-Direction
What are “Services Supporting Self-Direction?”
“Services…that allow enrollees to have the responsibility for managing all aspects of healthcare delivery in a person-centered planning process…Plans may provide services to assist in the establishment of decision-making authority for healthcare needs (e.g., power of attorney for health services) and/or may provide education such as financial literacy classes, technology education, and language classes. Interpreter services may also be provided to enrollees to facilitate encounters with healthcare providers. Plans may not include expenses for funerals as a covered benefit.”1
How many plans are offering Services Supporting Self-Direction in CY 2020?
20 PlansOffering Services Supporting Self-Direction in CY
2020 (17 plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
8 stateshave plans offering Services Supporting Self-Direction in at least one county in CY 20202
with 176,419 Medicare Beneficiaries
Enrolled in these 20 Plans in February 20203
Which organizations are offering Services Supporting Self-Direction?
✓ Capital Blue Cross✓ Health Partners, Inc.✓ Humana Inc.✓ Martin’s Point Health Care, Inc.✓ Steward Health Care System, LLC
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Services Supporting Self-Direction Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Structural Home Modifications
What are “Structural Home Modifications?”
“Structural modifications to the home that may assist in the chronically ill enrollee’s overall function, health, or mobility are permitted if those itemsand services have a reasonable expectation of improving or maintaining the health or overallfunction of the chronically ill enrollee (e.g., widening of hallways or doorways, permanent mobility ramps, easy use doorknobs and faucets).”1
How many plans are offering Structural Home Modifications in CY 2020?
44 PlansOffering Structural Home Modifications in CY 2020
(43 plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
Pennsylvaniahas plans offering Structural Home Modifications in
at least one county in CY 20202
with 453,509 Medicare Beneficiaries
Enrolled in these 44 Plans in February 20203
Which organizations are offering Structural Home Modifications?
✓ Geisinger Health
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
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Counties Where Structural Home Modifications Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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General Supports for Living/Transitional Supports
What are “General Supports for Living?”
“General supports for living such as housing may be provided to chronically ill enrollees if the benefit has a reasonable expectation of improving or maintaining the health or overall function of the enrollee. General supports for living may be provided for a limited or extended duration as determined by the plan. The benefit may include plan-sponsored housing consultations and/or subsidies for rent or assisted livingcommunities. Plans may also include subsidies for utilities such as gas, electric, and water as part of the benefit.”1
How many plans are offering General Supports for Living in CY 2020?
67 PlansOffering General Supports for Living in CY 2020 (60
plans excluding D-SNPs and MMPs)
Where are these benefits being offered?
4 states and Puerto Ricohave plans offering General Supports for Living in at
least one county in CY 20202
with 658,190 Medicare Beneficiaries
Enrolled in these 67 Plans in February 20203
Which organizations are offering General Supports for Living?
✓ Anthem Inc.✓ Capital Blue Cross✓ Geisinger Health✓ Humana Inc.✓ Medical Card System, Inc.
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, March 2020.
2727
Counties Where General Supports for Living Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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Other SSBCI
Source: ATI Advisory analysis of PBP files. 1. CMS Guidance. 2. Note: Analysis excludes Medicare Prescription Drug Plans and Employer/Union Only Direct Contract PDPs. 3. CMS’ Monthly Report by Plan File, February 2020.
What other SSBCI are plans able to offer?
In addition to the 10 services CMS listed as examples of SSBCI in their 2019 memo, plans are also able to offer up to 5 additional SSBCI. Plans input these additional SSBCI into a free text field in the plan bid tool.
In CY 2020, the only additional SSBCI plans chose to offer were “Service Dog Supports.”
How many plans are offering “Service Dog Supports” in CY 2020?
51 PlansOffering Service Dog Supports in CY 2020 (33 plans
excluding D-SNPs and MMPs)
Where are these benefits being offered?
14 stateshave plans offering Service Dog Supports in at least
one county in CY 20202
with 516,681 Medicare Beneficiaries
Enrolled in these 51 Plans in February 20203
Which organizations are offering Service Dog Supports?
✓ Anthem Inc.
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Counties Where Service Dog Supports Available in 2020
Note: This map does not include Hawaii, Alaska, or other U.S. territories (like Puerto Rico) where plans may be offered.
Source: ATI Advisory analysis of CMS PBP files.
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New Primarily Health-Related Supplemental Benefits
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Primarily Health-Related Supplemental Benefits:In-Home Support Services
ServiceNumber of Plans Offering in
2020Enrollment in Plans Offering this
Service in 2020
In-Home Support Services 223 1,137,267
Map of Counties Where Plans Offer In-Home Support Services, CY 2020
Source: ATI Advisory analysis of PBP files, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
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Primarily Health-Related Supplemental Benefits:Adult Day Health Services
ServiceNumber of Plans Offering in
2020Enrollment in Plans Offering this
Service in 2020
Adult Day Health Services 85 581,899
Map of Counties Where Plans Offer Adult Day Health Services, CY 2020
Source: ATI Advisory analysis of PBP files, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
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Primarily Health-Related Supplemental Benefits:Home Based Palliative Care
ServiceNumber of Plans Offering in
2020Enrollment in Plans Offering this
Service in 2020
Home Based Palliative Care 61 455,059
Map of Counties Where Plans Offer Home Based Palliative Care, CY 2020
Source: ATI Advisory analysis of PBP files, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
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Primarily Health-Related Supplemental Benefits:Support for Caregivers of Enrollees
ServiceNumber of Plans Offering in
2020Enrollment in Plans Offering this
Service in 2020
Caregiver Support 125 897,457
Map of Counties Where Plans Offer Caregiver Support, CY 2020
Source: ATI Advisory analysis of PBP files, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
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Primarily Health-Related Supplemental Benefits:Therapeutic Massage
ServiceNumber of Plans Offering in
2020Enrollment in Plans Offering this
Service in 2020
Therapeutic Massage 230 1,014,296
Map of Counties Where Plans Offer Therapeutic Massage, CY 2020
Source: ATI Advisory analysis of PBP files, excludes PDPs and PACE. Enrollment pulled from CMS’ March 2020 Enrollment by Plan file, which displays enrollment through February 7, 2020.
