Data Methodology and Definitions

Existing guidance in Chapter 4 of the Medicare Managed Care Manual states that meals are a primarily health-related benefit of temporary duration in specific circumstances:

• Immediately following surgery or an inpatient hospitalization (typically 4 weeks duration); as discussed in 42 CFR § 422.112(b)(3), after the temporary duration, the provider should refer the enrollee to community and social services for further meals, if needed.
• Due to a chronic condition, including but not limited to cardiovascular disorders, COPD, or diabetes (typically 2 weeks duration) as part of a supervised program designed to transition the enrollee to lifestyle modifications.

See Chapter 4 of the Medicare Managed Care Manual [PDF - 522 KB] for details.

Medicare-Medicaid Plans (MMPs) benefits that fall under "Other services."

See the Plan Benefit Package Checklist for Medicare-Medicaid Plans [PDF - 137 KB] for a list of services.

Nutritional/Dietary Benefit: General nutritional education for all enrollees through classes and/or individual counseling may be provided as a supplemental benefit as long as the services are provided by practitioners who are practicing in the state in which s/he is licensed or certified, and are furnishing services within the scope of practice defined by their licensing or certifying state (i.e., physician, nurse, registered dietician, or nutritionist). The number of visits, time limitations, and whether the benefit is for classes and/or individual counseling must be defined in the PBP (plan benefit package).

Medical Nutrition Therapy: MA plans may offer as a supplemental benefit additional hours of one-on-one MNT counseling provided by a registered dietician or other nutrition professional, to enrollees who are eligible for the Medicare Part B-covered MNT benefit; that is, those with diabetes, renal disease, or who have received a kidney transplant in the last 3 years.

In addition, MA plans may offer as a supplemental benefit one-on-one MNT counseling provided by a registered dietician or other nutrition professional, to all, or a disease-defined group, of its enrollees. As with all supplemental benefits, the MNT benefit’s primary purpose must be to improve health outcomes.

See Chapter 4 of the Medicare Managed Care Manual [PDF - 522 KB] for details.

Food and Produce: Food and produce to assist chronically ill enrollees in meeting nutritional needs may be covered as Special Supplemental Benefits for Chronically Ill Enrollees (SSBCI). Plans may include items such as (but not limited to) produce, frozen foods, and canned goods. Tobacco and alcohol are not permitted.

Meals may be offered beyond a limited basis as a non-primarily health-related benefit to chronically ill enrollees. Meals may be home-delivered and/or offered in a congregate setting if: 1) Needed due to an illness; 2) Consistent with established medical treatment of the illness; and 3) Offered for a short duration.

This analysis includes Healthy Living and Aging Support and Health Education benefits.

Get details on SSBCI [PDF - 109 KB].

Food and Nutrition: Qualifying benefits include primarily and non-primarily health-related supplemental benefits, such as meals (both primarily and non-primarily health-related) and food and produce (e.g., frozen foods, canned goods, and produce to assist enrollees in meeting nutritional needs).

Get details on VBID [PDF - 731 KB].