Expanding supplemental benefits to meet the needs of chronically ill enrollees
(i) In general
(i)In general#
For plan year 2020 and subsequent plan years, in addition to any supplemental health care benefits otherwise provided under this paragraph, an MA plan, including a specialized MA plan for special needs individuals (as defined in section 1395w–28(b)(6) of this title ), may provide supplemental benefits described in clause (ii) to a chronically ill enrollee (as defined in clause (iii)).
(ii)Supplemental benefits described#
(I) In general Supplemental benefits described in this clause are supplemental benefits that, with respect to a chronically ill enrollee, have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.
(II) Authority to waive uniformity requirements The Secretary may, only with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph, waive the uniformity requirements under this part, as determined appropriate by the Secretary.
(ii)(I)In general#
Supplemental benefits described in this clause are supplemental benefits that, with respect to a chronically ill enrollee, have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.
(ii)(II)Authority to waive uniformity requirements#
The Secretary may, only with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph, waive the uniformity requirements under this part, as determined appropriate by the Secretary.
(iii)Chronically ill enrollee defined#
In this subparagraph, the term “chronically ill enrollee” means an enrollee in an MA plan that the Secretary determines—
(I) has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee;
(II) has a high risk of hospitalization or other adverse health outcomes; and
(III) requires intensive care coordination.
(iii)(I)#
has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee;
(iii)(II)#
has a high risk of hospitalization or other adverse health outcomes; and
(iii)(III)#
requires intensive care coordination.