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Advancing Care through Innovation, Observation and Collaboration.

The Centers for Medicare & Medicaid Services have released new Medicare Advantage (MA) statistics. While the new numbers flag a general rise in MA enrollment and drop in premiums, they also reveal a significant expansion of the supplemental benefit programs.

According to CMS’ statistics, there will be 730 MA plans offering expanded, primarily health related supplemental benefits in 2021, including home-based palliative care. That figure is a 46% increase from the 500 MA plans to do so in 2020. Additionally, 920 plans — reaching 4.3 million beneficiaries — will be offering the Special Supplemental Benefits for the Chronically Ill (SSBCI) benefits in 2021, a nearly four-fold increase compared to the 245 plans to do so this year.

SSBCI includes in-home supportive services, but also benefits like transportation help, nutrition assistance and more — anything that helps chronically ill individuals stay in their home and out of the hospital. At this point, it’s unclear just how many of the MA plans operating in either the primarily health related pathway or under SSBCI are specifically offering in-home care in 2021. That information should become available in October.

Other Updates

Trump Administration Announces $20 Billion in New Phase 3 Provider Relief Funding

The Department ofHealth and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing $20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

Providers can begin applying for funds on Monday, October 5, 2020. For more information see here.

CMS Announces Update to Rate of COVID-19 Testing for Nursing Homes

On September 29, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country.

  • Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence.
  • Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.”

This information is critical to nursing homes, which are required to test their staff for COVID-19 at a frequency based on the positivity rate of their respective counties. This change means that counties that previously were required to test once a week will now only need to test once a month if there were 20 or fewer tests conducted over 14 days. Counties previously required to test twice a week will now only need to test once a week if they conducted both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10% positivity over 14 days.

CMS Model Helps Address the Health-Related Social Need

CMS is sharing a fact sheet with a snapshot of the data from the Accountable Health Communities (AHC) Model, reflecting the agency’s most comprehensive collection of social needs data to date. One in three beneficiaries (33 percent) reported at least one core health-related social need. Food needs were the most commonly reported (67 percent of those reporting at least one need), followed by housing (47 percent), transportation (41 percent), and utility assistance (28 percent). Of those screened, 18 percent were eligible for community navigation services, and 76 percent of eligible beneficiaries accepted the navigation assistance. The AHC Model addresses a critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization.

CBO Projects Federal Subsidies for Health Coverage for Individuals Under 65 to Rise in Coming Decade

Last week, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report detailing updated projections on the costs associated with federal subsidies for different types of health insurance. CBO and JCT project that net federal subsidies in 2021 for insured individuals will be approximately $920 billion or 4.4 percent of gross domestic product (GDP) and will reach $1.4 trillion (also 4.4 percent of GDP) in 2030. Over the 2021–2030 period, subsidies are projected to total $10.8 trillion. The spending during this period breaks down into 4 distinct categories: Medicaid and the Children’s Health Insurance Program (CHIP, Subsidies for employment-based coverage, Payments for Medicare, and Subsidies for coverage obtained through the individual marketplaces.

Stay up-to-date on C-TAC’s legislative and regulatory efforts by visiting our Policy & Advocacy page.

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