CMS Expands Benefit Flexibility In
Beginning in 2019, MA plans can leverage the new flexibility to partner with community-based organizations to create services aimed at addressing barriers to access to care or avoiding costly care.
The major new flexibilities for 2019 and beyond include:
Benefit Uniformity Flexibility:
In 2019, MA plans can design disease-specific benefits for individuals with certain chronic conditions or other high-risk health conditions if 1) they are available to all enrollees, 2) MA plans use objective and measurable medical criteria, and 3) beneficiaries’ diagnoses have been certified by a provider...
The previous “primarily health-related” definition has been expanded for supplemental benefits to permit coverage of services to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency healthcare utilization...