Sec. 2. Expanding supplemental benefits to meet the needs of chronically ill medicare advantage enrollees

497 words·~2 min read·/bill/115/hr/3168/ih/section-2

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Section 1852(a)(3) of the Social Security Act ( 42 U.S.C. 1395w–22(a)(3) ) is amended— in subparagraph (A), by striking Each and inserting Subject to subparagraph (D), each ; and by adding at the end the following new subparagraph: For plan year 2020 and subsequent plan years, in addition to any supplemental health care benefits otherwise provided under this paragraph, an MA plan, including a specialized MA plan for special needs individuals described in subsection (b)(6) of section 1859, may provide supplemental benefits described in clause

(ii)to a chronically ill enrollee (as defined in clause (iii)). Supplemental benefits described in this clause are supplemental benefits that, with respect to a chronically ill enrollee, have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits. The Secretary may, with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph, waive the uniformity requirement, as determined appropriate by the Secretary. In this subparagraph, the term chronically ill enrollee means an enrollee in an MA plan that the Secretary determines— has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee; has a high risk of hospitalization or other adverse health outcomes; or requires intensive care coordination. . The Comptroller General of the United States (in this subsection referred to as the Comptroller General ) shall conduct a study on supplemental benefits provided to enrollees in Medicare Advantage plans under part C of title XVIII of the Social Security Act, including specialized MA plans for special needs individuals described in section 1859(b)(6) of such Act ( 42 U.S.C. 1395w–28(b)(6) ). Such study shall be conducted in consultation with the Centers for Medicare & Medicaid Services and Medicare Advantage plans as necessary and, to the extent data is available, shall include an analysis of the following: The type of supplemental benefits provided to such enrollees, the total number of enrollees receiving each supplemental benefit, and whether the supplemental benefit is covered by the standard benchmark cost of the benefit or with an additional premium. The frequency in which supplemental benefits are utilized by such enrollees. The impact supplemental benefits have on— indicators of the quality of care received by such enrollees, including overall health and function of the enrollees; the utilization of items and services for which benefits are available under the original Medicare fee-for-service program option under parts A and B of such title XVIII by such enrollees; and the amount of the bids submitted by Medicare Advantage Organizations for Medicare Advantage plans under such part C. Not later than 5 years after the date of the enactment of this Act, the Comptroller General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Comptroller General determines appropriate.

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42 USC 1395w–22(a)(3)
42 USC 1395w–28(b)(6)

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Sec. 2

Expanding supplemental benefits to meet the needs of chronically ill medicare advantage enrollees

Cite42 USC 1395w–22(a)(3)

Cite42 USC 1395w–28(b)(6)

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