About This Work Search Methodology Information Collected Supplemental Benefit Definitions
Food and Produce
Meals (Beyond Limited Basis)
Indoor Air Quality Equipment and Services
Pest Control
Structural Home Modifications
Services Supporting Self-Direction
Social Needs Benefits
General Supports for Living
Transportation for Non-Medical Needs
Complementary Therapies
SELECT CATEGORY
About This Work
Search Methodology
Information Collected
Supplemental Benefit Definitions
About This Work

Medicare Advantage plans must be able to demonstrate, by the time they submit Contract Year 2025 bids, that Special Supplemental Benefits for the Chronically Ill (SSBCI) meet the legal threshold of having a reasonable expectation of improving the health or overall function of chronically ill enrollees, as supported by research. Specifically, Medicare Advantage plans must establish and maintain bibliographies of relevant research studies or other data to demonstrate that an SSBCI meets this threshold. To better understand the available evidence and research, ATI Advisory was funded by Better Medicare Alliance to compile literature available on the ten core SSBCI. This Excel Bibliography Database includes available research found through the methods described below, for articles and evidence published between 2014 and 2024.

Search Methodology

ATI Advisory developed a search strategy that entailed separate Boolean and non-Boolean search phrases, queried within PubMed1 and Google Scholar2, for each of the ten CMS-defined SSBCI benefits categories.3

A first search was executed using the PubMed database search function, with terms specifying a health outcome, intervention, age (excluded articles focused on children), and chronic conditions; limited to Meta-Analysis, Randomized Control Trial, and Systematic Review article types; and inclusive of full text. While this first search included relevant results, ATI Advisory determined refinement was needed given the number of additional irrelevant results returned. ATI Advisory revised the first search by: narrowing the search terms to reflect a shorter list of outcomes and interventions, removing the chronic disease terms and study type limitations, and restricting the search to title and abstract only. Relevant results from the first search were retained and added to the relevant results of the revised search terms.

Subsequently, ATI Advisory conducted a search in Google Scholar using different terms, given the inability to use the PubMed Boolean strategy in the Google Scholar functionality. Both PubMed and Google Scholar searches were limited to articles published since 2014. The searches were executed between February and May 2024.

As the growth of interventions focused on addressing social determinants of health and health related social needs is relatively recent within the Medicare program, the terminology used within programs and the body of literature is inconsistent and varied, which resulted in ATI Advisory using many search terms to be comprehensive. Also, ATI Advisory determined it was appropriate to include not only articles related to a specific social need intervention, but also those assessing the link between a relevant social need and a health impact. These articles are differentiated in the document under the column titled "Content Type."

ATI Advisory then reviewed the returned results for relevance to the ten CMS-defined SSBCI benefit categories for Medicare Advantage Organizations (MAOs). This process included a title review followed by an abstract review to confirm relevance. ATI Advisory excluded articles without any connection to health or overall function. ATI Advisory also excluded articles that were specific to a benefit that is offered through another part of the Medicare Advantage program. For example, articles exclusively focused on non-emergent medical transportation (NEMT) were excluded from the transportation benefit, as the SSBCI transportation benefit is defined as transportation for non-medical needs. For complementary therapies, a large volume of results was returned for tai chi and yoga interventions, and only relevant results from PubMed were necessary to include.

After narrowing the returned results to only those relevant, ATI Advisory compared this list to existing compendia of social intervention research. ATI Advisory identified relevant articles within the UCSF SIREN Evidence & Resource library4 that were not captured by ATI Advisory's peer-reviewed search and added them.

Finally, ATI Advisory conducted a Grey Literature review for benefit categories with less than 30 results. Grey Literature were only included once evaluated with the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist.5

Citations
  1. https://pubmed.ncbi.nlm.nih.gov/
  2. https://scholar.google.com/
  3. https://www.cms.gov/medicare/health-plans/healthplansgeninfo/downloads/supplemental_benefits_chronically_ill_hpms_042419.pdf
  4. https://sirenetwork.ucsf.edu/tools/evidence-library
  5. https://fac.flinders.edu.au/dspace/api/core/bitstreams/e94a96eb-0334-4300-8880-c836d4d9a676/content
  6. https://scholar.google.com/
Database categories
Boolean Search Terms PubMed Google Scholar
Food and Produce food delivery; grocery*; pantry; fresh produce; food and produce program; malnutrition; food insecurity grocery; pantry
Meals Beyond Limited Basis delivered meal*; meal delivery; home delivered meals; meal service; meal prep service; medically tailored meals meal delivery; in-home meal service
Pest Control pest control; infestation; pest control service; exterminator; pest*; environmental intervention; environmental remediation bug infestation; insect exterminator
Transportation for Non-Medical Needs transportation insecurity; rideshare; paratransit; public transit; nonmedical transportation; taxi; public transport*; transportation access non-medical transportation; rideshare
Indoor Air Quality Equipment and Services air filter; air purifier; humidifier; indoor air quality; dehumidifier; air conditioning services; carpet cleaning; pollution air purifier; indoor air quality
Social Needs companionship; social supports; social support program; social event*; isolation intervention*; social intervention*; companion services; loneliness social isolation social supports; social event; social isolation
Complementary Therapies complementary therap*; yoga; tai chi; herbal therapy; homeopathy; progressive muscle relaxation; complementary medicine; meditation; spinal manipulation; music therapy; sensory stimulation; guided imaging; hypnosis yoga; tai chi; complementary therapy; homeopathy
Services Supporting Self-Direction advance care planning; resuscitation preferences; power of attorney; living will; advance directives; financial literacy; technology literacy; end-of-life; interpreter services; sign language interpreter; financial literacy education; personal finance; technology education advance directives; advance directive planning; living will; financial literacy
Structural Home Modifications home improvement; home modification; stair lift; home retrofit; home access; mobility ramp; doorknob replacement; roll-in showers; lowering counters; lowering sinks; stair glide; vertical platform; widen hallways home modification; home improvement
General Supports for Living rental assistance; utility assistance; housing subsidies; housing assistance; housing support; broadband internet rental assistance; utility assistance; housing subsidies; housing support; broadband internet; internet access
Information Collected
Author

Author(s) of the article. (First author listed first, format: Last Name, First Name)

Publication Year
Year the article was published.
Study Type
Type of study described in the article; options include Randomized Controlled Trial, Prospective Cohort Study, Systematic Review, Meta Analysis, Case Study, Federal Policy or Report, Other.
Peer Reviewed
Yes or No indicating whether the article was published in a peer reviewed journal.
Intervention Summary
Description of the intervention, program, or change resulting in an impact on health.
Population: >65
Yes or No indicating if the population studied in the article was 65 years and older.
Population: <65
Yes or No indicating if the population studied in the article was 64 years and younger.
Population: Chronic Condition
If the article reflects a study of a population with a specific chronic disease that is allowable for purposes of SSBCI eligibility.
Population: Chronic Condition 2
If the article reflects a study of a population with a specific chronic disease that is allowable for purposes of SSBCI eligibility.
Population: Chronic Condition 3
If the article reflects a study of a population with a specific chronic disease that is allowable for purposes of SSBCI eligibility.
Outcome Type
Whether the study supports a reasonable expectation that the provision of the benefit would improve or maintain health or function; options include Favorable (article supports reasonable expectation), Neutral (article has inconclusive or mixed findings), and Unfavorable (article does not support reasonable expectation).
Outcome Description
Description of the health or function impact found by the article.
Journal or Organization
Journal or organization that published the article.
Search Site
Website where the search was conducted; options include PubMed, Google Scholar, and Google.
PMID
DOI
Hyperlink
Link to the source where the article was accessed.
Supplemental Benefit Definitions
In addition to the definitions below, ATI Advisory conducted a review of a sample of Evidence of Coverage documents from MA plans offering SSBCI to determine relevant terms related to benefit offerings.
Food and Produce
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. Tobacco and alcohol are not permitted.
Meals (Beyond Limited Basis)
Existing guidance in Chapter 4 of the Medicare Managed Care Manual provides that meals are a primarily health related benefit (PBP category B13c) in limited situations: when provided to enrollees for a limited period immediately following surgery, or an inpatient hospitalization, or for a limited period due to a chronic illness. In those situations, a meals supplemental benefit is permissible if the meals are: 1) needed due to an illness; 2) consistent with established medical treatment of the illness; and 3) offered for a short duration. Meals may be offered beyond a limited basis as a non-primarily health related benefit (PBP category B19b/13i) to chronically ill enrollees. Meals may be home delivered and/or offered in a congregate setting.
Indoor Air Quality Equipment and Services
Equipment and services to improve indoor air quality, such as temporary or portable air conditioning units, humidifiers, dehumidifiers, High Efficiency Particulate Air filters, and carpet cleaning may be covered as SSBCI. Plans may also include installation and servicing of equipment as part of the benefit.
Pest Control
Pest eradication services that are necessary to ensure the health, welfare, and safety of the chronically ill enrollee. Services may include pest control treatment(s) or products that may assist the enrollee in the pest eradication (e.g., traps, pest control sprays, cleaning supplies).
Structural Home Modifications
Structural modifications to the home that may assist in the chronically ill enrollee’s overall function, health, or mobility are permitted if those items and services have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee (e.g., widening of hallways or doorways, permanent mobility ramps, easy use doorknobs and faucets).
Services Supporting Self-Direction
Services supporting self-direction allow enrollees to have the responsibility for managing all aspects of healthcare delivery in a person-centered planning process; while such services are a non-primarily health related benefit, they may have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee. Plans may provide services to assist in the establishment of decision-making authority for healthcare needs (e.g., power of attorney for health services) and/or may provide education such as financial literacy classes, technology education, and language classes. Interpreter services may also be provided to enrollees to facilitate encounters with healthcare providers. Plans may not include expenses for funerals as a covered benefit. Primarily health related education (e.g., Health Education, Medical Nutrition Therapy) that is consistent with existing guidance (see Chapter 4, section 30.3) for primarily health related supplemental benefits may be offered by an MA Plan as a supplemental benefit in PBP category B14c.
Social Needs Benefits
Access to community or plan-sponsored programs and events to address enrollee social needs, such as non-fitness club memberships, community or social clubs, park passes, and access to companion care, marital counseling, family counseling, classes for enrollees with primary caregiving responsibilities for a child, or programs or events to address enrollee isolation and improve emotional and/or cognitive function, are non-primarily health related benefits that may be covered as SSBCI.
General Supports for Living
General supports for living such as housing may be provided to chronically ill enrollees if the benefit has a reasonable expectation of improving or maintaining the health or overall function of the enrollee. General supports for living may be provided for a limited or extended duration as determined by the plan. The benefit may include plan-sponsored housing consultations and/or subsidies for rent or assisted living communities. Plans may also include subsidies for utilities such as gas, electric, and water as part of the benefit. These benefits should be entered in Section B19b/13i of the PBP under “Transitional Supports.”
Transportation for Non-Medical Needs
Transportation to obtain non-medical items and services, such as for grocery shopping, banking, and transportation related to any other SSBCI, is a non-primarily health related benefit. Such transportation may be reimbursed, arranged, or directly provided by an MA plan as a SSBCI.
Complementary Therapies
Complementary therapies offered alongside traditional medical treatment may be offered as non-primarily health related SSBCI. Complementary therapies must be provided by practitioners who are licensed or certified, as applicable, in the state in which they practice and are furnishing services within the scope of practice defined by their licensing or certifying state. Alternative therapies that are considered primarily health related may be offered by an MA plan as a supplemental benefit in PBP category B14c.