CMS Expands Medicare Rewards - Adds Key Tool to Drive Behavior Change

By Michael Dermer

The recent changes to Medicare Advantage (MA) plans released by the Center for Medicare & Medicaid Services (CMS) in the final MA and Part D Rule are now in full effect – giving MA plans more flexibility to offer rewards and incentives to its recipients partcipating in wellness programs. The revamped regulations give Medicare recipients more opportunities to earn rewards and incentives for choosing healthy behaviors and actions. Welltok’s Michael Dermer outlines the welcomed changes to the MA’s expanded regulations below:

Removing Dollar Limit: One of the most significant developments is the removal of the $15 per instance and $50 per year dollar limit per member. CMS eliminated a set maximum dollar limit per activity or per year. It noted, “in this final rule, we neither identify limits for how often rewards and incentives may be offered nor do we set a maximum monetary value for the rewards and incentives.” The regulations simply state that there will be “a monetary cap as determined by CMS of a value that may be expected to impact enrollee behavior but not exceed the value of the health related service or activity itself.”

Expansion of Behaviors: CMS also noted that it “would like to enable MA organizations to offer health-driven rewards and incentives programs that may be applied to more health-related services and activities than are allowed under our current guidance.”

Previously, these organizations were only able to reward zero-cost screening and prevention measures. CMS now empowers MA recipients with rewards to participate in activities that focus on prevention – promoting improved health and the efficient use of healthcare resources. This provides MA plans with opportunity to apply rewards to a wider variety of health and wellness programs.

Progress vs. Completion: This authorizes MA plans to grant rewards even if the entire goal has not been reached, instead of the provision limiting such rewards to the completion of the program.

By making this change under which “MA organizations may reasonably define the scope” of their programs, CMS said in the final rule, it will be possible for “smaller increments of service or activity to be defined as the ‘entire service or activity’” qualifying for a reward. The statements constitute an important clarification for MA sponsors and by enabling plans to pay rewards for meeting incremental goals rather than just for achieving the full target of a difficult program such as weight loss, it will help the sponsors promote long-term healthy behavior change.

For more information about the changes to Medicaid Advantage plans – check out the full article here.