The Bipartisan Budget Act Boosts Medicare: Flexibility And Financing For Healthcare Plans And Providers

On Friday, February 9, 2018, President Trump signed the Bipartisan Budget Act of 2018 (the "Budget"), a two-year budget which, in significant part, made substantial revisions to Medicare, including the Medicare Advantage (MA) program. Such revisions include:

the addition of non-medical services (e.g., home-delivered meals, transportation to and from a physician's office, etc.) and telehealth services to the range of MA-covered services that an MA plan (Plan) can offer to its members; a significant increase in federal funding for services provided by federally qualified health centers (FQHCs); disbanding the Independent Payment Advisory Board (IPAB), a board comprised of presidential appointees whose sole authority and responsibility was to cut Medicare costs and expenses; and an increase in the discounts that pharmaceutical companies must give seniors enrolled in Medicare Part D drug plans by making the so-called "doughnut hole" disappear in 2019. The above Medicare-related changes were part of the "Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017" (the "Act") - a bipartisan bill that passed the Senate last October and was incorporated into the Budget during the final throes of Budget negotiations.

The following includes a more in-depth discussion of each of the Budget items described above.

Extended Coverage for Services Under Medicare Advantage Plans - New Supplemental Benefits and Telehealth Benefits for MA Plans and ACOs

The Act contains various warmly-received modifications to the Medicare program including the addition of language that allows providers to have greater flexibility to care for their chronically ill patients. As a result of the Act's provisions as incorporated into the Budget, the Act allows reimbursement of supplemental services provided by MA plans to chronically ill enrollees. Supplemental benefits are any benefits that have a reasonable expectation of improving or maintaining the health or overall function of a chronically ill patient. Supplemental benefits are not limited to being primarily health-related benefits, which allows MA plans to provide services such as transportation to and from a physician's office or meal delivery services. Additionally, the Act will provide for reimbursement of telehealth services provided by MA plans and Accountable Care Organizations (ACOs) to attempt to extend the reach of health services to chronically ill patients.

Federally...