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In a recently published MA Rule, CMS acknowledges C-TAC comments. Below is a summary of the highlights from these final rules on the Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs:
See the full report HERE – below are highlights where CMS acknowledges C-TAC comments with page numbers for reference.
Standardizing Housing, Food Insecurity, and Transportation Questions on Health Risk Assessments
We agree that assessing health-related social risk needs is very important, both to improve care for those with serious illnesses and to reduce health disparities. Our suggestion is that such an assessment be comprehensive enough to identify all the key SRFS, including the needs of family caregivers, since caregiver burden can prompt an emergency department visit or hospitalization[i] and is, therefore, also health-related. We appreciate the need to balance comprehensive assessment with potential burdens to the beneficiary and provider and would encourage you to study which are the key SRFs that need to be assessed.
|Via CMS – pg 74: A few commenters suggested adding questions about caregiver burden in particular noting that early recognition of caregiver burden can lead to targeted supports, and a lack of recognition of caregiver burden can prompt an emergency department visit or hospitalization… |
Response: We may consider adding more, specific question topics in future rulemaking. We note that current regulations do not contain any specific requirements similar to what we are adopting in this rule, and we believe it is appropriate to first assess experiences implementing the change we are finalizing in this rule before proposing to require questions on other topics.
We disagree, however, that the proposed rule does not explicitly propose “that SNPs be accountable for resolving all risks identified in these assessment questions, but that the results from the initial and annual HRAs be addressed in the individualized care plan”. It does little good to assess for social needs if there are not corresponding referrals to needed services. Therefore, we would ask that the agency consider going beyond just requiring assessment since referrals are what is needed to address these social risk factors. And, in many cases, even referrals are not enough if services are not actually available or available on a timely basis. Delivering services is the ultimate goal and we would ask that the agency work with MA plans to find a way to both assess, refer, and then confirm that needed social services have been delivered/received.
|Via CMS – pg 101: A few commenters believed that screening without a strong referral and navigation system is ineffective, disrespectful, and unethical, and it can undermine enrollee trust in providers… |
Response: We thank the commenters for their perspective on this issue. We agree that it is important for SNPs to not only assess their enrollees for social risk factors, but also connect them to needed services based on enrollee goals and preferences, whether such services are plan- covered benefits or referrals to community resources. We believe requiring all SNPs to include questions on enrollees’ housing stability, food security, and access to transportation will help inform the comprehensive individualized plan of care required; these individualized plans of care identify goals developed with the enrollee and measurable outcomes as well as describe specific services and benefits. In the proposed rule, we provided several examples of the ways in which SNPs could consult with enrollees about their unmet social needs as part of the development of individualized care plans, such as making a referral to an appropriate community partner. We appreciate the need for additional technical assistance on addressing the social needs of enrollees and will consider it in the future.
Supplemental Benefits Inadequate Data Systems
|We want to draw your attention to one of the challenges associated with providing expanded supplemental benefits in the recent ASPE final report[ii] Comparing New Flexibilities in Medicare Advantage with Medicaid Long-Term Services and Supports: Final Report. Supplemental benefits have been a wonderful way to increase support for those living with serious illness and are therefore to be promoted as much as possible. However, the ASPE report notes that “current data systems are not adequate to accurately track the use of these expanded benefits. The types of benefits offered, including expanded supplemental benefits, are included in the Medicare PBP bid submissions. Several studies used this database to determine the adoption of supplemental benefits across MA plans. However, because of differences in methodology and interpretations of services that qualified as supplemental benefits, the research varied when quantifying supplemental benefit uptake. As MAOs adopt supplemental benefits with greater frequency, this variation will make it difficult to accurately monitor MA plans’ benefit expansion”. We therefore recommend that future proposed rules for MA address this issue and require reporting to better monitor benefit expansion and address any issues or health equity disparities such monitoring may reveal.|
Via CMS – Pg 294: Several commenters also requested more oversight and data collection of supplemental benefits…
Response: We appreciate the commenters’ perspectives and thank the commenters for their input. These comments will inform our collaboration with States on D-SNP integration.
To view C-TAC’s full comments, visit our regulatory webpage here.