Key Points
- Medicare Advantage plans may offer SSBCI to chronically ill enrollees, which may include nutrition-related supplemental benefits in accordance with the criteria below. SSBCI must have a reasonable expectation of improving or maintaining the health or overall function of the enrollee.
- The definition of a chronically ill enrollee for SSBCI eligibility is established in statute under section 1852(a)(3)(D) of the Social Security Act and may not necessarily include all enrollees with a chronic condition.
- SSBCI are required to be approved by CMS.
- These benefits may be non-primarily health-related supplemental benefits that address chronically ill enrollees’ social determinants of health as long as the benefits maintain or improve the health or function of that chronically ill enrollee.
- Medicare Advantage plans may consider social determinants when determining eligibility for an SSBCI of health as a factor to help identify chronically ill enrollees whose health could be improved or maintained with SSBCI.
- Medicare Advantage plans may not use social determinants of health as the sole basis for determining eligibility for SSBCI.
FIM Opportunities
SSBCI are designed to support Medicare beneficiaries who are chronically ill.
Nutrition-related supplemental benefits can be provided as part of SSBCI as long as specific criteria are met. Food and produce to assist chronically ill enrollees in meeting nutritional needs may be covered as SSBCI. Plans may include items such as (but not limited to) produce, frozen foods, and canned goods.
