A Turning Point in Medicare Policy

Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill 

THE ISSUE

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, signed into law on February 9, 2018, updates fundamental principles of the Medicare program. Notably, the law allows coverage of non-primarily health related benefits through the Medicare Advantage program, as well as significant flexibility around who is eligible for these benefits and the services they receive.

For the first time, Medicare Advantage plans have significant flexibility in designing Special Supplemental Benefits for the Chronically Ill (SSBCI) that meet the individual needs of enrollees. While the SSBCI are a relatively small part of the Medicare Advantage program, the significance of this shift highlights the need for new principles to guide the implementation of SSBCI so that Medicare Advantage payers and providers can succeed in improving healthcare for chronically ill Medicare beneficiaries.

OUR WORK

With funding from The SCAN Foundation, we partnered with The Long-Term Quality Alliance to convene and lead a working group comprised of national experts on Medicare Advantage and long-term services and supports to develop Guiding Principles for New Flexibility Under SSCBI. These principles illustrate a new common vision for how Medicare can create the necessary flexibility to meet individual needs balanced with appropriate guardrails to protect beneficiaries, providers, Medicare Advantage plans, and the integrity of the Medicare program overall.

The Guiding Principles for New Flexibility Under SSBCI reflect a shared vision to guide a diverse array of stakeholders as they work to develop, implement, offer, deliver, and use SSBCI.

OUR VIEW

The considerations and next steps to realize these principles will require ongoing commitment of resources on the part of all stakeholders. They also require an unprecedented degree of collaboration among all stakeholders, especially health plans and providers.