By Tim Mullaney
| April 2, 2018
Non-skilled
in-home care services will be allowed as a supplemental benefit for Medicare
Advantage (MA) plans in 2019, the Centers for Medicare & Medicaid Services
(CMS) announced in a final rule issued Monday.
The
benefit 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.”
The
rule was originally proposed in February and was met with enthusiasmfrom the home health and private duty
home care industries. Home health care providers have already made great
strides as partners in MA contracts, and adding non-skilled services opens the
door to the growing MA population even further.
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.
“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 flexibilities than the fee-for-service providers do.
They don’t have a homebound requriement 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.
Even
before today’s final rule, some providers have been positioning themselves to
take on more personal care, with an eye toward MA trends.
“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.”
With
the merger of Almost Family closed as of April
1, LHC Group sees itself as having a big advantage to add in-home care supports
to its MA contracts.
“[With]
Almost Family, many people don’t know that they started 40 years ago as a
personal care services business,” Myers said. “So they have a long history of
personal care services and are second to no one with recruiting, retention, and
managing those type of employees. We want to leverage that.”
Access
the full rate announcement and call letter here.
Written by Amy Baxter and Tim
Mullaney
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