Medicare Advantage value-based design expanded for 2019

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Fifteen new states will participate in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model for 2019, allowing insurers in a total of 25 states to enter the program aimed at encouraging enrollees to focus on services that are of the highest clinical value to their specific chronic conditions.

States where the model will now be available in 2019 are: California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Virginia and West Virginia. For 2018, insurers were allowed to apply to participate in Alabama, Arizona, Indiana, Iowa, Massachusetts, Michigan, Oregon, Pennsylvania, Tennessee and Texas.

“This administration is committed to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans,” CMS Administrator Seema Verma, MPH, said in a statement. “CMS expects that this demonstration will provide insights into future innovations for the Medicare Advantage program.”

Other changes announced for the VBID model in 2019 were similar to “flexibilities” on benefit design for MA and Medicare Part D included in a recent proposed rule from CMS. Chronic Conditions Special Needs plans will be allowed to participate in the model, enrolling beneficiaries with different chronic conditions than CMS had previously included, including lower back pain, chronic kidney disease, obesity/pre-diabetes, asthma, and tobacco use.

MA plans which want to participate in the VBID model in 2019 will need to request and then complete an application by Jan. 26, 2018. Current participants will also need to reapply by the same date.