Medicare Advantage Will Allow In-home Care as Supplemental Benefit in 2019

April 5, 2018

The Centers for Medicare and Medicaid Services (CMS) has announced that non-skilled, in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019. This is the first time that CMS has allowed supplemental benefits which include daily maintenance for recipients of 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, with that figure expected to grow exponentially in the coming years. The proposal was originally put forth in February and has garnered great support from home health and private duty home care industries. Home health care providers have long been moving forward as partners in Medicare Advantage contracts, and many insurers and payors have been positioning themselves to better align with post-acute care services for years.

It is strongly believed that most MA payors are prepared and willing to pay for non-skilled, in-home care services, particularly with the shift of healthcare toward more personalized care. 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.

The addition of this service opens the door to the growing MA population, allowing high-needs patients to receive further personal care and avoiding the potential of further complicated and costly medical issues.

Source: “Home Care Providers Plan to Seize New Medicare Opportunity,” by Tim Mullaney, Editor, Aging Media Network, April 3, 2018