GUIDE FOR MEDICARE ADVANTAGE PLANSHow to Design a Home-Delivered Meals Benefit for 2021Including Special Supplemental Benefits for the Chronically Ill

Table of Contents

1 Introduction

2 Understanding the Options for Including aMealsBenefitinYourPlanDesign

3 Step1:IdentifyYourTarget

5 Step 2: Forecast Cost and Utilization

6 Step3:DetermineMeasurementCriteria

8 Step4:IncludeaMealsBenefitinYourBid

9 Step5:CommunicateYourBenefit

Theinformationcontainedhereisprovidedforinformationalpurposesonly,andshouldnotbeconstruedaslegaladviceonanymatter.

Thismaterialmaynotreflectthemostcurrentdevelopments.ThecontentandinterpretationofthelawsandCMSguidanceaddressedin

thisdocumentissubjecttorevision.Donotactorrefrainfromactinguponthisinformationwithoutseekingprofessionallegalcounsel.

DearColleague:

Therehasbeenanever-growingawarenessabouttherolenutritionplaysinoverallhealth.

Thelinkbetweentheaccesstohealthyfoodsandtheabilitytomanageachronicconditionto

avoidflare-upsandpoorhealthoutcomesistooimportanttoignore.It’snosurprisethatan

increasingnumberofhealthplansnowofferbenefitstomeettheneedsofindividualswith

chronicconditions.

Asyoumaybeaware,manychangesresultedfromtheBipartisanBudgetActof2018,which

includedtheCreatingHigh-QualityResultsandOutcomesNecessarytoImproveChronic

(CHRONIC)CareAct.Thelawexpandedwhatqualifiesasasupplementalbenefittomeetthe

needsofchronicallyillMedicareAdvantage(MA)enrollees.Atthesametime,theCentersfor

Medicare&MedicaidServices(CMS)issuedsimilarMArulechanges.

Today,MAplanshavegreaterflexibilitythaneverbeforetooffersupplementalbenefitstomembers

withspecificchronicillnesses.Onesuchbenefitishome-deliveredmeals.

That’s where Mom’s Meals fits in.

Mom’sMealsispleasedtosharewithyouaGuideforMedicareAdvantagePlans:HowtoDesign

aHome-DeliveredMealsBenefitfor2021(includingSpecialSupplementalBenefitsforthe

ChronicallyIll).

Wearealeadingnationalproviderofrefrigerated,home-deliveredmealsandnutritionservicesfor

individualsrecuperatingathomeafteraninpatienthospitalstayorpersonsmanagingachronic

condition.Our team works with hundreds of health plans nationwide, including MA and

Medicaid plans, that have implemented or plan to implement a home-delivered meals benefit.

Wehavedeepknowledgeoflegislativepolicysurroundingnutritionservicestopopulationsin

needandarepassionateaboutimprovinghealthoutcomes.

The 2021 benefit year is around the corner. Let’s work together to design a home-delivered

meals benefit under Special Supplemental Benefits for the Chronically Ill (SSBCI) for your

members with chronic conditions.

1

2

GO TO MARKET IN 2021 WITH YOUR HOME-DELIVERED MEALS BENEFIT

ManyMAplansarealreadyunderwayintheireffortstoestablishahome-deliveredmealsbenefitforthe2021

benefityear.Whereareyouinthisprocess?Now is the time to get started.

UNDERSTANDING THE OPTIONS FOR INCLUDING A MEALS BENEFIT IN YOUR PLAN DESIGN

Historicallyandeventoday,manyplanscovermealsbenefitsonalimitedbasis.Often,membersreceive

home-deliveredmealsforaperiodoftimesubsequenttoaninpatienthospital,skillednursingorrehab

stayinanefforttohelpthemrecoverafteranillnessorinjuryandavoid areadmission.

OnApril24,2019,CMSissuedamemotoMAplansponsorsdetailingnewbenefitsthatmaybeofferedto

enrolleeswithchronicconditions.Itdefinedthescopeunderanewcategoryofsupplementalbenefit,called,

“Special Supplemental Benefits for the Chronically Ill” (SSBCI).1 FilingyourbenefitunderSSBCIallowsyou

totailorbenefitsformemberswithchronicconditionsandinnovatewiththenewlyavailableflexibilityin

benefitdesign.

CMSgivesMAplansnewflexibilitytoofferbenefits

that"haveareasonableexpectationofimprovingor

maintaininghealthoroverallfunctionofanindividualas

itrelatestotheirchronicconditionorillness,"including:

• Mealsfurnishedtotheenrolleebeyond

alimitedbasis

• Transportationfornon-medicalneeds

• Pestcontrol

• Indoorairqualityequipmentandservices

• Benefitstoaddresssocialneeds

CMSmakesseveralclarificationswithrespect

tospecificSSBCIbenefits.Theseareimportant

tounderstandsincetheydifferfromprevious

years.2Whenitcomestomealsbenefits

under SSBCI:

• Mealsbenefits“maybeofferedbeyond

alimitedbasis.”

• Mealsbenefitsdonothavetobe

“uniform.”Plansmaytailorbenefitsto

theneedsofspecificenrolleesbased

upontheircondition.

Benefit Type

Eligibility

Benefit Flexibility

Uniformity Flexibility

2019 2020

“Targeted”

AllMAbeneficiariesSpecifichealthstatus

or disease state

Abilitytotailorsimilarlysituatedbeneficiaries

Supplementalbenefits areuniformacross allbeneficiaries

Benefitsmust:(1)notbecoveredbyoriginalMedicare; (2)mustbeprimarilyhealth-related(new,moreflexibledefinition)

(3)MAplanmustincuranon-zerodirectmedicalcost

“Chronic”

“Chronicallyill” beneficiaries

(definedinstatute)

Benefitthathasareasonableexpectationofimprovingor

maintainingenrolleehealthoroverallfunction

Abilitytotailortoindividualbeneficiaries’specificmedical

condition & needs

“Standard”

SUPPLEMENTAL BENEFITS FLEXIBILITY3

About 73% of MA enrollees have one or more of the identified chronic conditions.5

Chronic ConditionsEnrolleesmeetthisrequirementiftheyhaveaconditiondefinedin

theMedicareManagedCareManual(MMCM)asachroniccondition.4

• Alcohol or other drug dependence

• Cancer

• Certainautoimmunedisorders

• Certaincardiovasculardisorders

• Certain chronic lung disorders

• Certainhematologicaldisorders

• Certain neurological disorders

• Congestiveheartfailure

• Dementia

• Diabetes

• End-stageliverdisease

• End-stagerenaldiseaserequiringdialysis

• HIV/AIDS

• Stroke

Hasahighriskof

hospitalization

orotheradverse

healthoutcomes

Hasoneormorecomorbid

andmedicallycomplex

chronic conditions that is life

threateningorsignificantly

limitstheoverallhealthor

function of the enrollee

1 2

Thereisnorequirementthatan

individualparticipatesincare

coordination.AslongasanMA

planhasestablishedaprocess

todetermineifanindividual

meetsthestatutorydefinition

andclearlydocumentsits

determinationthatabeneficiary

meetsthedefinition,theplan

isnotrequiredtoensurean

individualis“participating”in

intensivecarecoordination.

Requiresintensive

care coordination

3

Definition of a Chronically Ill EnrolleeToqualifyforSSBCI,beneficiariesmustmeetallthreeofthesecriteria:

3

STEP 1: IDENTIFY YOUR TARGET

54

Mom's Meals provides detailed reporting on benefit utilization and

can help you ensure your benefits are being utilized at anticipated rates.

Indefiningtheirbenefit-eligiblepopulation,

somehealthplanschoosetonarrowtheir

focusandofferhome-deliveredmealsto

thoseforwhomthebenefitcanhavethe

greatestimpact.

Consider:

• Mostexpensivediseasecategories

• Memberswithahighrisk

ofadmission

• Riskscores

• Readmissionsrates

• Comorbidities

• Memberswithsocialdeterminants

ofhealth(SDOH)needs

CMSallowsplansflexibilityandhasnotsetforthspecificrules

fordefiningcriteria.However,allorganizationsmustclearly

definewhoiseligibleforSSBCI,andmustdocumenteligibility

criteriatoensurecommunicationtomembersisconsistent

andnon-discriminatory.

Ensure that enrollees who meet eligibility requirements

can access benefits, despite cultural or language barriers,

use of assistive technology, disabilities or health disparities.

Thisgoalshouldbebalancedwithavoidingunnecessary

administrativeburdenonproviders,plansorenrollees.

5

Mom’s Meals is happy to share with you studies proving home-delivered meals positively impact the lives of chronically ill enrollees and contribute to overall lower health spending.

How much will it cost to add a home-delivered meals benefit? How many meals should be included? Who will take advantage of the benefit? What kind of outcomes could your health plan expect?

Asyoudesignyourbenefit,youneedanswerstokeyquestionslikethese.Inpartneringwithyouractuarialteam,

Mom’sMealscanhelpyouforecasttheimpactofyourhome-deliveredmealsbenefitbasedonourworkwith

hundredsofhealthplansacrossthecountry.

Foryourhealthplan,home-

deliveredmealscantranslateinto:

• Fewerreadmissions

• Shorter lengths of stay

in the hospital

• Lowertotalcostofcare

Atypicalprogramdesignforchronic

careenrolleesmaylooklikethis:

• 12-weekcycleofmeals

• 2–3condition-appropriate

mealsperdayuntilthe

condition is controlled

Anexampleofreturnoninvestmentforchroniccaremealsmaylooklikethis:6

Without Meals With Meals

Investment $0 ~$588,000

Hospitalizations 125 63

(25%admitrate) (12.5%admitrate; 50%reduction)

Lengthofstay(days) 5.2 3.1 (40%reduction)

IPcosts($2,500/day) $1,625,500 $488,250

Net cost savings, annual $0 $1,137,250*

DoesnotincludecostsavingsonER,emergencytransportationorothercosts,orqualitybonuspayments.

ThereisnoguaranteethatyourprogramdesignorbenefitwillresultinsimilarROIresults.

ROI RANGE = 2:1-4:1 BASED ON BENEFIT DESIGN

PATIENTS = 500 QUALIFYING 500 HIGHEST-RISK MEMBERS

FOR 12 WEEKS OF MEALS WITH 2 MEALS/DAY

STEP 2: FORECAST COST AND UTILIZATION

6

1 MEMBER SATISFACTION & ENGAGEMENT

How satisfied are members with your home-

delivered meals benefit? Were case management

encounters more successful?

Forexample…

InamembersatisfactionsurveybyaMom’sMeals

partner,95%ofrespondentssaidMom’sMeals

helpedthemmanagetheirchroniccondition,and

98%wouldrecommendtheplanbecauseitoffered

ahome-deliveredmealsprogram.

Did you realize a lower rate of hospital

admissions/readmissions among enrollees?

Forexample…

Astudyreporteda38%reductionin30-day

readmissionsforpatientsreceivingpost-discharge

meals.

2 ADMISSIONS/READMISSIONS

Has the length of inpatient stays decreased

among enrollees?

Forexample…

AstudypublishedinJournalofPrimaryCareand

CommunityHealth6foundthatmemberswho

receivemealshavefewerhospitalreadmissions

(50%),shorterlengthsofinpatientstay(37%)and

lowertotalcostofcare(31%).

3 LENGTH OF INPATIENT STAY

Has the number of trips to the ER decreased

among enrollees? Have enrollees used

emergency transportation less frequently?

Forexample…

AstudypublishedinHealthAffairs7 reported a

70%reductioninemergencyroomvisitsbydually

eligibleMedicareandMedicaidbeneficiarieswithin

asix-monthtimeperiod.

4 ER & EMERGENCY TRANSPORTATION USE

Whileinthedevelopmentphase,thinkaboutthecriteriayou’llusetomeasuretheresultsofyourbenefit.

Thissteppresentsaprimeopportunitytobringcross-functionalareasoftheplantogetherforalignment

aroundthenewbenefit.

Theresultsyoumeasurecanhelpyouto:

• Improveclinicaloutcomesformembers

• Stengthenandincreaseyourplanperformanceinfuturebenefityears

• ContributetohigherHEDISandStarratings

• Differentiateyourplantoenrolleesandnetworkproviders

• Assist CMS in addressing the cost of chronic conditions

• Addressfoodinsecurityformemberswithunmetsocialneeds

Basedonourexperience,Mom’sMealshaspinpointedeightmainmeasurementcriteria:

STEP 3: DETERMINE MEASUREMENT CRITERIA

Has there been a decrease in total cost of care

among enrollees?

Forexample…

AstudypublishedbyHealthAffairs8 reported

thatmealdeliveryprogramsreducetheoverall

healthcarespendinduallyeligibleMedicareand

Medicaidbeneficiariesby40%.

5 TOTAL COST OF CARE

What type of clinical improvements have

enrollees experienced?

Forexample…

Astudyamongpeoplewithdiabetesbya

Mom’sMealspartnershowedatherapeutic

reductioninbodymassindex(5.8%).

6 CLINICAL IMPROVEMENTS

Has your home-delivered meals benefit helped your

plan achieve higher HEDIS and/or Star measures?

Forexample…

AstudyamongpeoplewithdiabetesbyaMom’s

Mealspartnershowedtherapeuticimprovements

inbloodsugarcontrol(5.9%),whichhelped

toaddresstheStarmeasureforDiabetesCare

(ControlledBloodSugar).

7 HEDIS & STAR MEASURES

Are enrollees talking about how home-delivered

meals have impacted their lives? What are

they saying?

QuotesfromafewrecipientsofMom’sMeals:

“Iorderedthediabeticfood.Thishashelpedmeto

managemydiabeticnumbers.”

“Mom’sMealspreventmefromeatingjunkfoodand

havehelpedmelose35poundsoverthelastyear.”

8 INDIVIDUAL OUTCOMES/SUCCESS STORIES

7

8

Home-deliveredmealsincludedas

SSBCI are considered a non-primarily

health-related benefit.

Home-deliveredmealsmaybeprovided

beyond a limited basis asanon-primarily

health-relatedbenefittochronicallyill

enrollees,undertheSSBCIprovisions.

SSBCI are not time limited, whichallows

MAplanstheflexibilitytodesignthebenefit

forhome-deliveredmealsforthelengthof

timetheybelievewillcreatethemostvalue.

Mealsofferedasanon-primarilyhealth-

relatedbenefittochronicallyillenrollees

undertheSSBCIprovisionsarenot required

to meet the uniformity requirements.

ClarifiedbyCMSinitsHPMSMemoradum(ImplementingSupplementalBenefitsfor ChronicallyIllEnrollees5(April24,2019))

NON-PRIMARILY HEALTH-RELATED SUPPLEMENTAL BENEFIT FOR CHRONICALLY ILL ENROLLEES

CONSISTENT WITH THE SSBCI PROVISIONS (filed in PBP Category B9b/13i)

1

Manyplanshavealreadyincludedhome-deliveredmealsas

a primarily health-related benefit.Someplansfiledifferent

benefittypesfordifferentplans,suchasHMO,PPO,D-SNP

andC-SNP.

Home-deliveredmealsmaybeprovidedona limited

basis consistentwithexistingguidancesetforthinthe

MedicareManagedCareManual(MMCM).

Forexample...

• Immediatelyfollowingsurgeryoraninpatienthospital

stay,foratemporaryduration,(typicallyafour-week

period),providedtheyareorderedbyaphysicianor

non-physicianpractitioner

• Forachroniccondition,includingbutnotlimited

tocardiovasculardisorders,COPDordiabetesfora

temporaryperiod,typicallytwoweeks.Mealsmustbe

orderedbyaphysicianornon-physicianpractitioner

andbepartofasupervisedprogramdesignedto

transitiontheenrolleetolifestylemodifications.

Primarilyhealth-relatedbenefits fall under uniformity

requirements andmustbeavailabletoallplanmembers.

PRIMARILY HEALTH-RELATED SUPPLEMENTAL BENEFIT (filed in PBP Category B13c)

2

What About Nutrition Education?Healtheducationandmedicalnutritiontherapy(MNT)offeredassupplementalbenefitsareconsidered primarily

health-related, andshouldbefiledinPBPCategoryB14c.Theservicesmustbeprovidedbypractitionerswho

arepracticinginthestateinwhichs/heislicensedorcertified,andarefurnishingserviceswithinthescopeof

practicedefinedbytheirlicensingorcertifyingstate.(i.e.,physician,nurse,registereddietitiannutritionist).

STEP 4: INCLUDE A MEALS BENEFIT IN YOUR BID

Whenpreparingyourbid,youhaveseveraloptionsforincludingahome-deliveredmealsbenefit.Mealsare

coveredasasupplementalbenefitthatmaybeincludedinanMAplanundertwoprimarycategories.

STEP 5: COMMUNICATE YOUR BENEFIT

OnceyourbenefitspackageisapprovedbyCMS,youwillneedtomovepurposefullyandswiftlytoleteligibleand

prospectivemembers,casemanagers,yourprovidernetwork,andagentsorbrokersknowthathome-delivered

mealbenefitsarenowavailableunderyourplan.

Outreach to Eligible Members

Inallcases,home-deliveredmealsbenefitsmustbeexplainedwithinplanmaterials,

suchastheEvidenceofCoverage,memberhandbookorotherofficialplandocuments.

TomakeiteasyforourMAplanpartners,Mom’sMealshascreatedalibraryofattractive,

easy-to-usematerialstocommunicatewitheligiblemembersabouttheplan’sspecific

home-deliveredmealsbenefit.Thesehavebeenusefulnotonlyinhelpingeligible

memberstomakeinformeddecisionsaboutparticipating,butalsoforestablishinga

pointofdifferentiationfortheplan.

Outreach to Case Managers & Care Coordinators

Casemanagersandcarecoordinatorswillhavedirectcontact

withenrolleeswhoareeligibleforyourhome-deliveredmeals

benefit.Introducecasemanagerstoyourbenefit,andhelp

themtounderstandhowitworksandwhat’sincluded.

ForourMAplanpartners,Mom’sMealshasconductedon-

siteandvirtualtrainingsessionswithcasemanagerstoteach

themaboutthebenefit,howtoaccessthebenefit,andhow

toidentifyandrefereligiblemembers.

Outreach to Your Provider Network

Mealscanbeahelpfultooltoproviders

whoarecaringformemberswith

chronicconditions.

Mom’sMealsisabletodelivertoanyU.S.

address,whichmeansthatyoucansupport

memberslivinginhard-to-reachareaswho

maybenefitfromhome-deliveredmeals.

9

Talkwithourteamaboutdevelopingahome-delivered

mealsbenefitspecificallyforyourchronicallyill

membersunderSSBCIforthe2021benefityear.

Catherine Macpherson, MS, RDN,

VP Product Strategy and Development,

Chief Nutrition Officer

Catherine.Macpherson@momsmeals.com

Direct:1.844.280.2134

John Phillips

Vice President, National Program Development

John.Phillips@momsmeals.com

Direct:1.888.343.8020

Sources1,5AnnouncementofCalendarYear(CY)2020MedicareAdvantageCapitationRatesandMedicareAdvantageandPartDPayment

PoliciesandFinalCallLetter.U.S.DepartmentofHealth&HumanServices,CentersforMedicareandMedicaidServices.April1,2019.

https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2020.pdf2KathrynColeman.ImplementingSupplementalBenefitsforChronicallyIllEnrollees,U.S.DepartmentofHealth&HumanServices,

CentersforMedicareandMedicaidServices,Washington,DC,memorandumissuedApril24,2019.https://www.cms.gov/Medicare/

Health-Plans/HealthPlansGenInfo/Downloads/Supplemental_Benefits_Chronically_Ill_HPMS_042419.pdf3LTQAQualityAlliance.MedicareAdvantage’sNewSupplementalBenefitfor2019:PlanViewsandResponses.November14,

2018.http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images/LTQA-Report-on-MA-Flexible-Supplemental-Benefits-

FINAL-11-9-18.pdf4MedicareManagedCareManual–Chapter16-B,Section20.1.2.https://www.cms.gov/Regulations-and-Guidance/Guidance/

Manuals/Downloads/mc86c16b.pdf6AudreyJ.Weiss,Ph.D.andAnneElixhauser,Ph.D.OverviewofHospitalStaysintheUnitedStates,2012.AgencyforHealthcare

ResearchandQuality,HealthcareCostandUtilizationProject,StatisticalBrief#180,October2014.https://www.hcup-us.ahrq.gov/

reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf7SethA.Berkowitz,MD,MPH;JeanTerranova,JD;LiisaRandall,PhD6;KevinCranston,MDiv;DavidB.Waters,MA;JohnHsu,MD,

MBA,MSCE.AssociationBetweenReceiptofaMedicallyTailoredMealProgramandHealthCareUse.JAMAApril22,2019JAMA

InternMed.2019;179(6):786-793.doi:10.1001/jamainternmed.2019.0198.8SethA.Berkowitz,JeanTerranova,CaterinaHill,ToyinAjay,ToddLinsky;MealDeliveryProgramsReducetheUseofCostlyHealth

CareinDuallyEligibleMedicareandMedicaidBeneficiaries,HealthAffairs,Vol.37,No.4,April2018