Medicare Updates n4a Aging Policy Briefing April Ben F. Belton Center for Medicare Advocacy

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1 Medicare Updates 2018 n4a Aging Policy Briefing April 2018 Ben F. Belton Center for Medicare Advocacy MedicareAdvocacy.org

2 The Center for Medicare Advocacy is a national non-profit law organization founded in 1986 that works to advance access to comprehensive Medicare and quality health care Headquartered in CT and Washington, DC Staffed by attorneys, advocates, nurses, and technical experts Education, legal analysis, writing and assistance Systemic change Policy & Litigation Based on our experience with the problems of real people Medicare appeals Medicare/Medicaid Third Party Liability Projects MedicareAdvocacy.org 2

3 PEOPLE WITH MEDICARE 3

4 BIPARTISAN BUDGET ACT of 2018 BBA - Signed into law on February 9, 2018 (Public Law No ) Medicare-related provisions include the following: Repeal of Medicare Outpatient Therapy Caps Since 1997, outpatient therapy (physical, speech and occupational) under Medicare Part B has been subject to annual dollar limits, or caps. An exceptions process which has allowed beneficiaries and providers to seek coverage above the caps, expired December 31, The BBA permanently repeals the caps. However, it continues to require providers to attach a modifier code to claims above the current cap level ($2,010) to indicate the services are medically necessary, and claims above a higher limit ($3,000) may be subject to a targeted manual medical review. 4

5 BIPARTISAN BUDGET ACT of 2018 Closes Part D Donut Hole One Year Early The Part D coverage gap, or Donut Hole, will be closed in 2019 rather than 2020, as mandated by the Affordable Care Act. In 2019, Part D enrollees will be responsible for paying 25% cost-sharing on brand name drugs in the Donut Hole rather than 30%. Beneficiaries will also enter the catastrophic coverage phase earlier in 2019 since more drug costs will count towards meeting the coverage threshold. 5

6 BIPARTISAN BUDGET ACT of 2018 Steve Gleason Enduring Voices Act This Act builds upon the Steve Gleason Act of 2015 by permanently fixing restrictions in the law that limited Medicare coverage and access to Speech Generating Devices (SGDs) which are a crucial means of communicating for people with ALS and other degenerative diseases. Coverage of the SGD is moved from the rental payment category to the purchase payment category, which means users can take their SGD anywhere and keep it for as long as necessary. 6

7 BIPARTISAN BUDGET ACT of 2018 Further Means Testing Medicare Premiums Medicare beneficiaries with incomes of $85,000 (or $170,000 for a couple) already have to pay higher premiums for both Part B and Part D coverage. Beginning in 2019, individuals with income of $500,000 or more ($750,000 for couples) will pay an even higher share of their premiums than they pay under current law (85% v. 80%). 7

8 BIPARTISAN BUDGET ACT of 2018 Home Health Changes The Budget Act includes a number of provisions relating to the Medicare home health benefit that, among other things, will implement a payment model that may further reduce access to Medicare-covered home care. In addition to reducing a home health episode of payment from 60 days to 30 days beginning in 2020, the law eliminates the use of therapy thresholds. Beginning in 2019, eligibility determinations can be based on a review of the patient s medical records, including documentation in the HH agency records. 8

9 BIPARTISAN BUDGET ACT of 2018 Increases Flexibilities of Accountable Care Organizations (ACOs) including allowing certain ACO models to elect to have beneficiaries assigned at the beginning of the year, beneficiary options to align their ACO with their primary care provider, and an incentive program allowing certain ACOs to make cash incentive payments to benes receiving qualifying primary care (up to $20 per service) Renews Independence at Home extends demonstration for 2 years and expands the number of participants; testing whether providing home-based primary care to individuals with multiple chronic conditions and functional limitations can improve health outcomes and lower costs Expands Telehealth and Other Technologies 9

10 BIPARTISAN BUDGET ACT of 2018 Provisions Improving/Expanding Services and Coverage in Medicare Advantage Only Expanding Supplemental Benefits to Meet the Needs of Chronically Ill Medicare Advantage Enrollees - starting in plan year 2020, MA plans can provide supplemental benefits to chronically ill enrollees. Supplemental benefits are defined as benefits that 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. Chronically ill enrollee is defined as someone who has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of enrollee; has a high risk of hospitalization or other adverse health outcomes; and requires intensive care coordination. 10

11 BIPARTISAN BUDGET ACT of 2018 Provisions Improving/Expanding Services and Coverage in Medicare Advantage Only MA Special Needs Plans (SNPs) Permanently reauthorized (set to expire at the end of 2018) Other changes, including enhanced coordination between states and federal government re: D-SNPs, including re: appeals and grievances Expands Value Based Insurance Design (VBID) demonstration to all states in 2020 Expands Telehealth allows MA plans to include telehealth as a basic benefit, built into base premium bids beginning in

12 CURES ACT 2019 Medicare Advantage Disenrollment Period (MA-DP) Eliminated Restoration of the Medicare Advantage Open Enrollment Period - new MA open enrollment period (OEP) from January 1st through March 31st annually; allows individuals enrolled in an MA plan, including newly MA-eligible individuals, to make a one-time election to go to another MA plan or Original Medicare; individuals using the OEP can make a change may make a coordinating change to add or drop Part D coverage 2021 Beginning in 2021, people with End-Stage Renal Disease (ESRD) will be able to enroll in MA plans. 12

13 MEDICARE & FISCAL SOLVENCY False narrative that Medicare is going bankrupt Part A v. Part B financing Part A Trust Fund projected solvency through 2029 ACA extended by 11+ years Part B funded by general revenues and beneficiary premiums Medicare spending growth has slowed in recent years, and is expected to grow at a slower rate in the future than in the past (KFF) 13

14 PRINCIPLES for MEDICARE REFORM Medicare Reform CMA Core Considerations 1.Adequate & Available (Coverage) 2.Affordable (For beneficiaries) 3.Simplicity (Easy to understand & navigate) 4.Sustainable (For Medicare program) 5.Fair (For all beneficiaries & between delivery options) 14

15 New Medicare Cards 15

16 Ben F. Belton DC: CT: For further information, to receive the Center s free weekly electronic newsletter, CMA Alert, update s and webinar announcements, contact: Communications@MedicareAdvocacy.org Or visit MedicareAdvocacy.org