Who, What, & How: Understanding New SDOH Payments in Medicare Advantage

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) finalized the rule to allow Medicare Advantage (MA) plans to pay for certain non-clinical supports and services as “supplemental benefits” to address the social determinants of health (SDOH) for chronically ill patients.

The wonky acronym for the new rule: SSBCI, which stands for “special supplemental benefits for the chronically ill.” The punchline is easier to understand: MA plans can pay for meals, transportation, home modifications, pest control, and other non-clinical stuff starting next year.

The vast majority of this new rule is very similar to CMS’ initial proposal, though the final reg contains some new clarity around how plans can...