Healthcare reform, Home Health, News

CMS proposes nonskilled service coverage as additional benefit to Medicare Advantage

On February 1, 2018, CMS proposed new Medicare Advantage and Part D payment and policy updates to provide new benefits, some nonskilled, for enrollees.

The development, if passed, could change how agencies focus their business.

“I think for private duty, this is a big plus,” says Diane Link, director of clinical services with Conshohocken, Pa.-based BlackTree Healthcare Consulting. “I think it also gives opportunity for private duty agencies to really start considering having skilled care as part of their services so that they can provide that continuity of care and give themselves more advantage in the market.”

As part of the proposal, CMS is redefining health-related supplemental benefits to include services the increase health and improve quality of life. This includes coverage of non-skilled in-home supports, portably wheelchair ramps and other assistive devices and modifications when patients need them.

CMS has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy announced today, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. CMS estimates a 1.84% year-to-year percentage average change in revenue from MA.
“What specifically those benefits are will likely be up to individual MA plans to determine,” says Link.

Comments on the proposed Advance Notices and Draft Call Letter containing this proposal are invited from industry, seniors, consumer advocates, and the public and must be submitted by March 5, 2018. The 2019 Final Rate Announcement and Call Letter will be published on Monday, April 2, 2018.