May 22, 2020

Inside Health Policy Quotes Michael Adelberg on CMS’s “Sleeper Provision”

Faegre Drinker Consulting principal Michael Adelberg was quoted in the Inside Health Policy article, “CMS Finalizes D-SNP Look-Alike, Star Ratings Policies in MA Rule.” The publication reports that CMS finalized a number of Medicare Advantage (MA) policies for 2021, including loosening of network adequacy requirements, limiting so-called Dual Eligible Special Needs Plans (D-SNP) look-alikes and reworking aspects of MA star ratings. Under the final rule, D-SNP look-alikes would be able to transition their membership into a D-SNP or another qualifying zero-premium plan offered by the MA organization beginning for the 2021 plan year.

Adelberg told Inside Health Policy this D-SNP “sleeper” provision in the bill is CMS’s decision to give plans more freedom to decide what chronic conditions qualify beneficiaries for special supplemental benefits. “The sleeper provision in the reg may be allowing MA plans to select their own chronic conditions for State Small Business Credit Initiative (SSBCI) benefits. This may arrive too late to change 2021 plans, but MA organizations and their members will benefit greatly in the future from the ability to select their own conditions,” Adelberg said.

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Michael S. Adelberg

Principal - Healthcare Providers & Plans Practice Lead - Faegre Drinker Consulting

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