Beginning in 2019, non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday, April 8th. This ruling, originally proposed in February, was met with enthusiasm from both the home health and private duty home care industries.
This marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. “CMS is expanding the definition of ‘primarily health related,’”the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”
In 2015, 35% of Medicare beneficiaries were participants in MA, according to CMS data. And that figure is expected to grow quickly over the next several years. Home care providers are not the only ones welcoming this change, as many also believe MA payors are ready and willing to pay for non-skilled in-home care services but as of yet did not have a mechanism to do so.
“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group ElevatingHome, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibility than the fee-for-service providers do. They do not have a home bound requirement in many cases. So they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”
In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.
“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve have a great relationship for skilled home health and hospice for quite a while,” Keith Myers, CEO of LHC Group (Nasdaq: LHCG), told HHCN. “In the last few years, they’re starting to focus more on dual-eligible population and have needed us to have a bigger commitment in personal services.”