Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available for download via HPMS in April.
Included with the PBP Beta Software is a list of changes to each of its sections. As MA and Part D plans prepare for Contract Year (CY) 2020 bid submissions and materials, here are a number of important CY20 Medicare Advantage benefits changes and PBP changes.
Section B-7: Health Care Professional Services
B-7j: Additional Telehealth
This is a new Medicare-covered section. Plans can offer Additional Telehealth services for any Medicare-covered benefit. Although it is a Medicare-covered benefit, it will be optional for plans.
B-7k: Opioid Treatment Services
This is a new Medicare-covered section. It will be mandatory for plans.
Section B-14: Preventive and Other Defined Supplemental Services
B-14c: Other Defined Supplemental Benefits
- The section’s name has been updated from its CY19 name “Eligible Supplemental Benefits.”
- The section includes the addition of these new supplemental benefits: Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees.
Section B-19: VBID/MA Uniformity Flexibility/SSBCI
- The section’s name has been updated from its CY19 name “VBID/ MA Uniformity Flexibility.”
- The section includes Special Supplemental Benefits for the Chronically Ill (SSBCI) along with the already existing Uniform Flexibility (UF) and Value-based Insurance Design (VBID) benefits. Only one SSBCI package is allowed in 19a and 19b. SSBCI Packages do not select disease states.
- Plans can include any combination of UF, VBID, and/or SSBCI benefits.
- 19a is for reductions in cost-sharing for Medicare-covered and/or non-Medicare-covered benefits.
- 19b is for the addition of supplemental benefits.
Every contract year, CODY analyzes the PBP Beta Software and makes updates to our data sources and the CodySoft® system to reflect the changes.
By Kelly Altmann
Vice President, Member Communications