Sign in now, Important Information About MedicarePlans. Finally, it is Icarios position that introducing prohibitions on retailers like Walmart, Target (and potentially others like them, e.g. A federal government website managed by the The incentive limits in EEOC's 2016 rules were challenged by the American Association of Retired Persons (AARP) as being too high and potentially coercive. Your card can be used at many retailers. FAQs on New CMS Rules for Rewards & Incentives in Medicare Advantage According to CMS, the goal of rewards and incentives in Medicare Advantage "is to encourage enrollees to be actively engaged in their health care and, ultimately, improve and sustain their overall health and well-being." In 2016, CMS expanded the ability to offer rewards and incentives, but more improvements are needed. Cigna Medicare Advantage Incentives Program Updates Reward and incentive program is a program offered by an MA plan to qualifying individuals to voluntarily perform specified target activities in exchange for reward items. For Members: Medicare Advantage Rewards | BCBSM Part I of this chapter provides key information for Medicare Advantage Organizations (MAOs) regarding Medicare Advantage (MA) benefits for use in designing Plan Benefit Members can earn rewards by completing some or all program activities. The Final Rule took that guidance and codified it into regulation. This preloaded spending card offers access to incentive rewards and select benefit allowances as part of your Medicare Advantage Plan. https:// Last month, the Centers for Medicare and Medicaid Services (CMS) finalized its guidance on Rewards and Incentive Programs (RI Programs). SUBJECT: Rewards and Incentives Program Guidance . An MA organization that offers an R&I program must comply with all marketing and communications requirements in subpart V of this part. TTY users can call 1-877-486-2048. Lower cost Why are value-based programs important? and Plug-Ins, End-Stage Renal Disease QualityIncentiveProgram (, Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM), Skilled Nursing Facility Value-Based Purchasing (. PDF 2023 OVER-THE-COUNTER BENEFIT GUIDE - Cigna Healthcare The Value Of Small Changes To The Medicare Advantage Risk-Adjustment Log into myCigna to access your card benefits VIDEO Using Your Cigna Healthy Today Card New for 2023, the Cigna Healthy Today card was created exclusively for Medicare Advantage customers. (e) Marketing and communication requirements. This demonstrates a seismic shift in priorities in just two years. GAO (US Government Accountability Office). Reward and incentive programs. The annual report projects that from 2022 to 2031, total U.S. health expenditures will grow by an average of 5.4 percent a year compared to an estimated 4.6 percent increase in the GDP, on average, over that same time period. The type 2 diabetes medication Ozempic and its close relative Wegovy, prescribed for weight loss, have taken the world by storm for their ability to help people shed excess pounds. Icario has always done this and continues to build in this strategy for optimum engagement. However, with 2022 right around the corner, its important to understand the impact of these new rules and what actions plans must take to avoid sanctions from CMS. Not only is committing to health equity the right thing to do, but its also becoming a requirement with CMS already updating policies to reduce discrimination and increase compliance and regulatory oversight. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). The site is secure. Other findings in the report include: Medicare costs are expected to grow by 7.5 percent a year between 2022 and 2031. that insure or administer group HMO, dental HMO, and other products or services in your state). Washington, D.C. 20201 Federal government websites often end in .gov or .mil. We provide health insurance in Michigan. On page 372 of the rule, CMS described changes to regulations for rewards and incentives (R&I) programs that were underreported on at the time. Rewards and Incentives Program Guidance | Guidance Portal - HHS.gov and procedures for Medicare services furnished, or paid for, by Medicare Advantage organizations through Medicare Advantage plans. Value-based programs also support our three-part aim: Our value-based programs are important because theyre helping us move toward paying providers based on the quality, rather than the quantity of care they give patients. most common FAQs that Healthmine has received into a downloadable handout. Please enable Javascript in your browser and try 91 Medicare Advantage plans are available in 2022, compared to 82 plans in 2021. Medicare Advantage Plans Need to Align Rewards and Incentives Programs Health equity is a top priority for most healthcare delivery organizations, with 58% of health professionals citing this as number one among six priorities. An official website of the United States government. .gov That would protect Medicare Advantage beneficiaries from low-performing plans while reducing overall Medicare spending. Annual growth in hospital spending is expected to average 5.8 percent. In early 2021, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2022 Medicare Advantage (MA) and Part D Final Rule with sweeping changes to reward and incentive programs for MA plans that mostly flew under the radar. GDP represents the value of all finished goods and services produced in the U.S., AARP Membership $12 for your first year when you sign up for Automatic Renewal. Private health insurance spending is projected to grow by an average of 5.4 percent a year over the next decade. That absence means comparisons can't be made between Medicare Advantage and traditional Medicare plans. The report also finds that while an all-time high of 92.3 percent of the population was estimated to be insured in 2022, that percentage is projected to drop in the coming years. As a Cigna Medicare Advantage customer, you have all the coverage of Original Medicare plus a wide range of added benefits. Unlike CMS other pay-for-performance programs, the quality bonus program does not penalize low-performing Medicare Advantage contracts to pay for better performers. The bonus program, established by the Affordable Care Act in 2010, offers 5% bonus payments to Medicare Advantage contracts with ratings of four stars or higher. For help with these documents, please call 1-877-774-8592. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Their incentive program is designed to reward customers for being proactive about their health. Medicare Advantage and Medicare Part D 2022 Final Rule 2022 CMS Medicare Advantage Readiness Checklist. Cigna's Medicare Advantage Customers Get Credit for Staying Healthy August 17, 2021 News Cigna Preventive care and screenings are vital to health, and Cigna wants your customers to stay as healthy as possible. PDF 2023 SUPPLEMENTAL BENEFITS GUIDE - Cigna Healthcare . Try adding 01 or 02 at the end of your Member ID, even though it's not on your insurance card. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. In addition to identifying and reaching out to a comprehensive set of qualifying individuals, its crucial to offer incentives and rewards that will motivate members to take the desired action. The current trend in wellness programs is toward health-contingent programs that reward employees for outcomes such as smoking cessation, weight loss, and managing chronic conditions like diabetes and high blood pressure and cholesterol. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. ADA and GINA incentive limits are no longer effective as of January 1, 2019. Rewards and Incentives Program Guidance Guidance for Medicare Advantage Organizations (MAOs) on implementing a Rewards and Incentives Program (RI Program) for their Part C enrollees. When healthcare professionals were asked to rank these priorities in 2019, only 25% indicated that health equity was top of mind. Incentive(s) program, reward(s) program, and R&I program mean the same thing as rewards and incentives program. For example, a program geared toward people with diabetes would be allowed as long as everyone is included and treated the same. Official websites use .govA Genetic Information Nondiscrimination Act (GINA). Federal Register :: Medicare and Medicaid Programs; Contract Year 2022 2023 Healthmine, Inc. All rights reserved. Cigna may not control the content or links of non-Cigna websites. Rationale for releasing early is predicated on accommodating the impact of COVID-19 on the healthcare . To summarize the changes at a very high level: Plans that are using HEDIS measure criteria to define incentive eligibility or including reloadable debit cards and Amazon gift cards as rewards will need to overhaul their programs or face potential penalties for non-compliance. PDF Medicare Managed Care Manual - Centers for Medicare & Medicaid Services An official website of the United States government. PDF DEPARTMENT OF HEALTH & HUMAN SERVICES Room 352-G - Centers for Medicare Although previous rules led to loose interpretations of qualifying individuals and allowable rewards, the new compliance standards are clearly defined and are likely to be accompanied by more stringent oversight: In order to implement R&I programs equitably, new regulations do not allow the use of HEDIS denominators and/or numerator status as the eligibility criteria to qualify for and/or earn rewards in MA. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: December 04, 2014 eCFR :: 42 CFR Part 422 -- Medicare Advantage Program How it works Step 1 To create and activate your online account you'll need your Blue Cross member ID card. In addition to encouraging a culture of health, these programs are designed to reduce health care costs for both employees and the company. The institute's report noted that combined, United Healthcare and Humana received $4.7 billion in bonuses last year. In the context of a non-plan-covered health benefit, qualifying individual means any plan enrollee (42 CFR 422.134). Annual Wellness Visit - $25 reward Annual Physical Exam - $25 reward Annual Flu Vaccine - $10 reward Health Risk Assessment - $25 Breast Cancer Screening (Mammogram) - $25 reward Colon Cancer Screening - $25 reward Diabetic HbA1c Test - $10 reward Diabetic Eye Exam - $10 reward Diabetic Kidney Function Test - $10 reward Members of the Medicare Payment Advisory Commission and Democratic policymakers have expressed concerns about the program, including inflated scores, limited data sets and its uselessness to consumers choosing a plan. (ii) Be a direct tangible benefit to the qualifying individual who performs the target activity. And because many plans want to support regionalor even localbusinesses, youll want to consider an experienced rewards partner that can integrate customized incentives. Cigna Medicare Advantage. Medicare Advantage | CMS However, its still permissible to provide rewards and incentives to a group with a particular chronic condition. The reward item for a target activity must meet all of the following: It has always been true that when providing a reward in exchange for someone completing a health action, you cant just send someone a check for $25and you cant send cash equivalents. Reprinted with AIS Health permission from the December 16, 2021, issue of RADAR on Medicare Advantage. (b) Offering an R&I program. SM. There are5 original value-based programs; their goal is to link provider performance of quality measures to provider payment: Sign up to get the latest information about your choice of CMS topics. It's not clear at all that the actual beneficiaries would notice that much difference between 79% and 84%, Skopec said. "Medicare Advantage Quality Bonus Demonstration." Washington, DC: GAO. Medicare Advantage (MA) Rewards and Incentives Provide higher-value MA Rewards and Incentives (RI) Programs than currently available under MA. Rewards and Incentives (RI) programs The overall goal of RI programs is to encourage enrollees to be actively engaged in their health care RI programs must be designed to elicit intended enrollee behaviors. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. Many employers offer wellness programs to support employees and their family members in improving their health. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Card. Use your rewards before they expire. The current trend in wellness programs is toward health-contingent programs that reward employees for outcomes such as smoking cessation, weight loss, and managing chronic conditions like diabetes and high blood pressure and cholesterol. It is Icarios intent to support our clients in providing our interpretation of these regulations, while respecting the fact that clients may reach different conclusions regarding the guidance and will expect Icario to be a supportive partner in managing this potential risk for them. Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data. When it comes to the types of health actions or target activities that can be tied to R&I offerings, there are a few considerations to keep in mind. In addition, plans must ensure that the rewards they offer are both compliant with CMS regulations and appealing to their members. Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Help with File Formats Your Cigna Medicare Advantage plan now includes a . MA organization must make information available to CMS upon request about the form and manner of any rewards and incentives programs it offers and any evaluations of the effectiveness of such programs. Rewards can be earned from January 1 to December 31, 2023. We could conceive of having more measures that focus on areas where people have expressed concerns about Medicare Advantage, like the quality of post-acute care, or disenrollment among people with high medical needs and those aren't covered in the current programming, she said. Marketing and communication requirements. Plans are required to offer the same reward for all qualifying individuals (not just those with a HEDIS gap), Qualifying individuals are those for which the service would be a covered benefit during the benefit year (You must offer the same reward to those who qualify, such as men for whom mammograms are medically required. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. To help you navigate these new regulations, weve compiled some of the most common FAQs that Healthmine has received into a downloadable handout. Stay healthy and get rewarded by signing up for the Rewards & Incentives program offered to Blue Cross Medicare Advantage members. A different privacy policy and terms of service will apply. Use numbers only. The model is designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, including dual-eligible beneficiaries, and improve the coordination and efficiency of health care service delivery. Formalizes that noncompliance with CMS R&I program requirements may result in sanctions. Controlling costs, improving employee health, and personalized service are just a few of the ways we can help your organization thrive. website belongs to an official government organization in the United States. Another new term that showed up in the regulation that caused some questions was the idea of uniformly offering rewards and incentives. Guidance for Medicare Advantage Organizations (MAOs) on implementing a Rewards and Incentives Program (RI Program) for their Part C enrollees. In 2025, Medicare spending is projected to increase by 8.9 percent, in part because of the. With the Cigna Medicare Advantage Incentives program, customers can earn up to $200 in 2023 for completing healthy activities. 200 Independence Avenue, S.W. ACTION: Final rule. Icario continues to work closely with clients to develop programs that fully comply with these R&I guidelines. Permissible reward items for a target activity may be reward items that: CMS, following guidance from the OIG, has explicitly included a prohibition on Amazon gift cards that are not limited to a specific health and wellness category, and they have clearly prohibited general purpose debit cards (such as VISA and American Express). Paying MA too much hurts everyone by increasing Part B premiums.. Medicare Advantage: The average monthly Medicare Advantage premium changed from $11.19 in 2021 to $11.21 in 2022. Under the new guidelines, health plans must limit rewards and incentives to specific products, retailers, or retail categories. Tips for Selecting Rewards/Incentives Activities Plans may consider the following promising practices when selecting reward activities: Identifying gaps in health promotion activities. As a Blue Cross Blue Shield of Michigan Medicare Advantage member it is easy and simple to earn rewards. (B) Can be used like cash (such as a general purpose debit card). These retailers are often the stores of choice for underserved populations who live in rural or urban areas with limited access to food and other daily living items. PDF RESEARCH REPORT The Medicare Advantage Quality Bonus Program This website is not intended for residents of New Mexico. To that end, Icarios immediate approach is: For the long-term, Icario is actively seeking to engage a gift card vendor who can provide a sku-limited gift card that allows members to shop wherever they choose to obtain a more limited selection of merchandise. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. There has been some limited enforcement action in the marketplace regarding continued use of Walmart cards that CMS finds unacceptable. * The final ADA regulations clearly state that the "bona fide benefit plan" safe harbor does not apply to rewards and penalties offered in connection with an employer's wellness program that includes disability-related inquiries or medical examinations, and go on to state that the EEOC does not agree with the outcome of the cases on this issue. CMS Seeks to Provide Flexibility and Facilitate Innovation in Medicare (i) If offering a reward and incentive program, the MA organization must include all costs associated with the reward and incentive program as an administrative cost and non-benefit expense in the bid for the year in which the reward and incentive program operates. However, allowable incentives have changed, and well review the impact in this article. Changes to the Medicare Advantage (MA) rewards and incentives programs; Revisions to requirements for Special Needs Plans (SNPs); New requirements from supplemental benefits; and Revisions and updates to the Programs of All-Inclusive Care for the Elderly (PACE) under the Medicare and Medicaid programs.