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On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of its draft 2020 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that want to participate in Medicare in the following calendar year. In collaboration with several other advocacy organizations, the Center for Medicare Advocacy (the Center) drafted and submitted comments regarding the draft Call Letter. The full comments are available at https://www.medicareadvocacy.org/center-comments-on-2020-medicare-parts-c-d-call-letter/.

The Center’s comments included the following points:

  • 2020 Star Ratings

The Center appreciates CMS’s stated objective of ensuring that the Star Ratings system accurately reflect plan quality and enrollee experience. We emphasize that we support quality ratings that accurately reflect quality of care, and reiterate our concerns about any changes to quality measurement that allow a plan’s quality rating to increase without any changes in the quality of care. We are concerned that this will mask disparities in care without addressing the poor care that disadvantaged patients disproportionately receive.

We strongly support CMS in seeking to utilize the Star Rating system to encourage continuous quality improvement in the MA and Medicare Prescription Drug programs, providing oversight to ensure accuracy and transparency, and not accepting any changes to performance measurement that would lead to masking disparities and harming disadvantaged patients.

  • Special Supplemental Benefits for the Chronically Ill (SSBCI) Available Through Medicare Advantage Plans in 2020

While SSBCI has the potential to benefit those who have access to it, at discretion of their individual MA plan, it is incumbent upon CMS to make every effort to similarly expand such services in traditional Medicare. While the Administration clearly cannot pass legislation to do so, it can and should use every opportunity to promote such expansion for the majority of Medicare beneficiaries who choose to remain in traditional Medicare.

We urge CMS to provide more guidance concerning how both the targeted benefits and SSBCI are marketed and explained to current and prospective enrollees.  As we have noted elsewhere, CMS’ 2019 marketing guidelines, renamed Communications & Marketing Guidelines, made no mention of new MA flexibilities in 2019. There is no guidance to plans about how such benefits can be described, nor are there any rules for agents and brokers concerning how such benefits will be marketed.  We are concerned that CMS will also forego providing guidance concerning SSBCI.

While SSBCI are not otherwise Medicare covered services, the same standards for covered items and services should apply. Partially citing language from the Bipartisan Budget Act, CMS notes that “MA plans will have the ability to offer a “non-primarily health related” item or service to chronically ill enrollees if the SSBCI has a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to the chronic disease.”

Although not directly in the statutory language, “maintenance” should be defined broadly to include preventing and/or slowing deterioration in an individual’s condition, as is found elsewhere in Medicare rules. This is also recognized by the settlement in the Jimmo v. Sebelius litigation brought by the Center and Vermont Legal Aid (No. 11-cv-17 (D.VT), filed January 18, 2011), which stands for the proposition that “[s]killed care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.”

March 7, 2019 – D. Lipschutz

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