New Cms Rule Provides More Flexibility for V-BID Benefits
in Medicare Advantage

On April 16, 2018, CMS officially published their new rule for the Medicare program contract year 2019.  This rule includes a reinterpretation of the Medicare Advantage (MA) uniformity requirement that will allow for more flexibility in benefit design for MA enrollees with specified chronic conditions.  CMS determined:

Providing access to services (or specific cost sharing) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly is consistent with the uniformity requirement in the Medicare Advantage (MA) regulations

Beginning in 2020, CMS will wave the uniformity requirement for MA plans that provide additional supplemental benefits to chronically ill enrollees.  This change paves the way for the further incorporation of V-BID principles into the Medicare Advantage program.  While the ongoing MA V-BID Model Test will continue, plans outside of the demo will now have the flexibility to offer V-BID benefit designs to their beneficiaries without being subject to the additional application and geographic limitations inherent to the model test.  Although the ability to lower cost-sharing for prescription drugs will remain a unique feature of the MA V-BID demo, the application of clinically nuanced V-BID strategies beyond the model test presents an enormous opportunity for the Medicare Advantage program.  V-BID can encourage the utilization of high-value providers and services, thus helping Medicare Advantage plans improve health and quality, enhance consumer engagement, and reduce costs.

For more information, visit our MA initiative page and see the resources below.