The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance and custodial care 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 enthusiasm from 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.
“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 this week’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 had a great relationship for skilled home health and hospice for quite a while,” said Keith Myers, CEO of LHC Group. “In the last few years, they’re starting to focus more on a dual-eligible population and have needed us to have a bigger commitment in personal services.”