CurrentAnthemPolicy N/A

Special Supplemental Benefits for the Chronically Ill (SSBCI) benefits update

Describes Anthem's filing and availability of new Medicare Advantage Special Supplemental Benefits for the Chronically Ill (SSBCI), who is eligible, and provider/member guidance on selecting benefits.

Policy Summary

PayerAnthem

PolicySpecial Supplemental Benefits for the Chronically Ill (SSBCI) benefits update

Policy CodePolicy N/A

Change TypeAdministrative/Operational update — new SSBCI benefits filed

Effective Date2020-01

Next Review DateN/A

Key ActionAnthem may contact providers to confirm a member meets CMS chronic illness criteria and that the physician concurs the SSBCI will help improve or maintain the member's condition.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipletypes of SSBCI benefits filed

CMS referencedpolicy follows CMS guidance

multi-stateAnthem entities

SSBCI Offering and Eligibility

SSBCI offering and eligibility

Covered when ALL of the following are met:

ALL of the following

Member must meet the chronic illness criteria defined by CMS.
Information may be verified in patient records or via contact with the member's provider to confirm a qualifying condition and that the physician concurs the benefit is expected to improve or maintain the member's condition.
Anthem may contact providers for confirmation when records do not show qualifying condition.
Not all SSBCI benefits are available on every Medicare Advantage plan; benefit availability is plan-specific.

Anthem encourages members to consult with their physician when selecting an elective SSBCI benefit to determine the most appropriate option for their needs.

Policy Summary

PayerAnthem

PolicySpecial Supplemental Benefits for the Chronically Ill (SSBCI) benefits update

Policy CodePolicy N/A

Change TypeAdministrative/Operational update — new SSBCI benefits filed

Effective Date2020-01

Next Review DateN/A

Key ActionAnthem may contact providers to confirm a member meets CMS chronic illness criteria and that the physician concurs the SSBCI will help improve or maintain the member's condition.

SourceLink

On This Page

Provider Confirmation and Actions

Documentation Required

Provider confirmation for SSBCI eligibility

Anthem must confirm SSBCI eligibility by obtaining provider confirmation that the member meets CMS criteria for being chronically ill and that the treating physician concurs the SSBCI benefit is reasonable to improve or maintain the member's health or overall function as it relates to the chronic condition. If provider documentation in the medical record does not clearly establish the qualifying chronic condition and physician concurrence, Anthem will contact the provider to obtain the necessary confirmation.

Confirm member meets CMS defined criteria for being chronically ill
Obtain physician concurrence that the specific SSBCI benefit is expected to improve or maintain the member's health/function related to the chronic condition
If not documented in records, contact the provider to secure confirmation
Encourage members to consult their physician when selecting elective SSBCI benefits

Key Definitions

SSBCI — definition and key facts

DefinitionSpecial Supplemental Benefits for the Chronically Ill (SSBCI) — CMS guideline permitting Medicare Advantage plans to offer expanded benefits or services that are reasonably expected to improve or maintain the health or overall function of an enrollee as it relates to a chronic condition or illness.

Examples of benefits filed by AnthemNutrition benefits (Healthy Nutrition, Prescribed Nutrition), pest control, and ADA-related support services.

Eligibility verificationAnthem must ascertain the member meets CMS criteria for being chronically ill; verification may come from patient records or by contacting the member's provider.

Provider rolePhysicians may need to concur that the SSBCI benefit is expected to help improve or maintain the member's condition and can assist members in selecting appropriate elective benefits.

Plan availabilityNot all SSBCI benefits are available on every Medicare Advantage plan; availability is plan-specific.