Skip to content Skip to navigation

CMS pilot model to provide additional benefits for chronic conditions

September 2, 2015
by Nicole Stempak, Associate Editor
| Reprints

The Centers for Medicare & Medicaid Services (CMS) will begin a pilot program to offer extra benefits and reduced costs for select Medicare Advantage enrollees beginning in 2017.

“The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, MD, MSc, CMS deputy administrator and chief medical officer in a CMS announcement.

The model provides new supplemental benefits to Medicare Advantage enrollees, including those with Part D benefits, who have diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), hypertension, coronary artery disease and mood disorders, as well as those with a history of stroke or other specified conditions.

The model gives health plans the flexibility to provide new supplemental benefits tailored to enrollees’ clinical needs, including eliminating co-pays for eye exams for beneficiaries with diabetes or extra tobacco cessation assistance for enrollees with COPD.

The pilot program will take effect Jan. 1, 2017, and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee.

Read the full announcement and register for a CMS-hosted webinar Sept. 24 here.

CMS will soon begin accepting applications for the MA-VBID via a Request for Applications. It will be available here.