Home Health & Hospice Week

Key: Help show that aide services will 'reduce avoidable emergency and healthcare utilization.'

Exactly how much a new broadening of the Medicare Advantage benefit rules will affect home care providers remains unclear, but it looks promising.

The change: The Centers for Medicare & Medicaid Services has finalized a February proposal to allow MA plans to cover aide services under their supplemental benefits, according to an April 2 Part D rate announcement and call letter for 2019.

Aide services don't qualify for inclusion under CMS's current definition of a supplemental health care benefit allowed in regulation, because the definition precludes services for "daily maintenance," the agency notes in the letter. "However, medical and health care research has demonstrated the value of certain items and services that can diminish the impact of injuries or health conditions and reduce avoidable emergency and health care utilization," CMS allows.

Therefore, "CMS is expanding the scope of the primarily health related supplemental benefit standard," it explains in the 270-page letter. Regulations don't define the term "healthcare benefits;" thus, CMS has "authority to interpret the term more broadly than we have in the past, to permit MA plans to offer additional benefits as 'supplemental benefits' so long as they are healthcare benefits."

CMS now says to qualify as "primarily health related," a service "must diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization." The definition change "will allow MA plans more flexibility in designing and offering supplemental benefits that can enhance beneficiaries' quality of life and improve health outcomes," the agency concludes in the letter.

The change will take effect in 2019.

"Home care services continue to demonstrate high value in all care delivery models, including managed care," National Association for Home Care & Hospice President William Dombi says. "By allowing Medicare Advantage plans to use caregivers in the home as a supplemental benefit, it can be expected that the plans will reduce overall care costs while improving patient outcomes." With MA participation at more than one-third of beneficiaries and rising, the change could be significant.

"Caregivers can be very helpful in making care transitions successful, avoiding initial and rehospitalizations,

and spotting potential exacerbations in the patient's clinical condition," Dombi explains in the NAHC newsletter. "That happens because they are in home with the patient and capable of assisting with care plan adherence and observing changes in the patient's condition. If done correctly by the plans, this will be a very positive move by CMS."

Another provision in the call letter that may affect home care providers is new opioid drug-utilization review standards.

Note: See the call letter at www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf.