Special Supplemental Benefits for the Chronically Ill (SSBCI)
Understanding Eligibility Requirements
What are SSBCI?
Special Supplemental Benefits for the Chronically Ill (SSBCI) are additional Medicare Advantage benefits, such as groceries and home utilities, that may be available to members who qualify based on their health conditions and other eligibility requirements.
Who is Eligible?
To qualify, members must meet all of the following CMS requirements:
✔ Have one or more chronic conditions
✔ Be at high risk of hospitalization or other adverse health outcomes
✔ Require intensive care coordination
How VNS Health Determines Eligibility
Eligibility is determined by reviewing available clinical and plan information, which may include:
| Information Reviewed | Eligibility Requirements |
|---|---|
| • Health Risk Assessment (HRA) | • Qualifying chronic condition(s) |
| • Claims history | • High risk of hospitalization or adverse health outcomes |
| • Clinical documentation | • Requires intensive care coordination |
| • Care management information | • Benefit is expected to improve or maintain health |
| • Other objective clinical information |
VNS Health evaluates whether you meet the CMS definition of a chronically ill person and whether a specific SSBCI has a reasonable expectation of improving or maintaining your health or overall function.
Chronic Conditions That May Be Considered
Autoimmune disorders • Cancer • Cardiovascular disorders • Chronic heart failure • Chronic kidney disease • Chronic lung disorders • Diabetes • Dementia • Stroke • Neurologic disorders • HIV/AIDS • Chronic gastrointestinal disease • Chronic mental health conditions • Immunodeficiency disorders • Post-organ transplantation • Severe hematologic disorders • Conditions requiring continued therapy • Functional challenges • Cognitive impairment • Overweight, obesity, and metabolic syndrome
Frequently Asked Questions
Yes. Your Care Manager will complete a Health Risk Assessment (HRA) with you to best document your chronic condition(s). It is important to make sure your Care Manager properly captures any underlying conditions you may have. Overall, the Health Risk Assessment aims to capture your chronic conditions as well to best coordinate your care.
Eligibility is determined and validated through conversations with your Care Manager and through the completion of the Health Risk Assessment form.
VNS Health reviews your Health Risk Assessment form as well as your claims as part of overall care management efforts.
Notification of eligibility typically occurs at the point of enrollment.