Providers Urge CMS to Enact Medicare Advantage Home Care Proposal

Private duty and home health care providers have weighed in on a recent proposal to include non-skilled in-home supports in Medicare Advantage plans in 2019, with some providers calling it a “precursor” to expanding home care services to all Medicare patients.

The proposal, which was announced by the Centers for Medicare & Medicaid Services (CMS) on Feb. 1, would potentially add private duty home care as a supplemental benefit to these plans. Industry stakeholders had a chance to weigh in on the proposal during on open comment period that closed March 5.

More than 1,200 comments were submitted in response to the overall Medicare Advantage proposal, but not all have been posted online and not all addressed the home care provision. However, several home care and home health providers weighed in, pointing out numerous questions still to be answered, but also expressing support for the policy shift.


Louisville-based Almost Family (Nasdaq: AFAM) and Lafayette-based LHC Group (Nasdaq: LHCG) stated they strongly support “expanding access to quality in home services through personal care services for MA and eventually all Medicare patients.” LHC Group and Almost Family are currently undergoing a merger; the deal is expected to close in April 2018.

MA plans currently cover about one-third of all Medicare patients and enrollment is expected to hit between 60% and 70% of all Medicare patients between 2030 and 2040. Almost Family has been very active and vocal when it comes to recent regulatory proposals impacting the home care industry, even proposing its own new payment system for home health last year.

Almost Family also noted that the MA benefits expansions should be added to traditional Medicare in the future, but that such a move would require more transparency from providers.


Remaining questions 

While industry support is clear, there are several remaining questions about how private duty home care providers could become involved in MA in 2019.

One anonymous comment asks: “Will Medicare Advantage plans be required to use only Medicare-certified home health agencies to provide the non-skilled home care services under the proposed supplemental benefit?”

According to Peter Ross, CEO of Senior Helpers, one of the nation’s largest private duty home care franchise companies, providers likely won’t need to be a Medicare-certified provider. Ross, who also sits on the Healthcare Leadership Council (HLC), based this interpretation on the available documents and conversations with the health care leaders and officials.

“All our franchises can participate in any program,” Ross told Home Health Care News. “We take Medicaid, VA. So far as I have see, there is no Medicare number needed, which is nice because we don’t have a Medicare provider number. We’ve seen that’s not the case, and what they are really saying so far is something all our locations can easily adopt.”

When the announcement was made, other providers immediately started looking to their current partners across the health care system to see how home care benefits could be added to plans, and even if they didn’t submit an official comment to CMS, they have been discussing the implications of the proposal. Frisco, Texas-based Addus HomeCare (Nasdaq: ADUS), one of the largest providers of personal care in the nation, is among these.

“Through the transition over the past few years to managed Medicaid in a majority of our markets, we have developed strong relationships with our managed care partners, and our teams are already having conversations with them about this opportunity,” Addus CEO Dirk Allison said Tuesday on a call discussing the company’s fourth-quarter and full-year 2017 earnings. “While it is too early to tell what the potential impact could be for Addus, this is another positive step toward expanding the availability of our service in a value-based market.”

Louisville-based ResCare is another large provider of personal care, and it too views the Medicare Advantage proposal favorably.

“It would be a huge opportunity,” ResCare CEO Jon Rousseau told HHCN last week. “I think it’s real reinforcement that non-medical models of care really provide a lot of value and help keep people out of the hospital and in their homes, where they want to be.”

CMS will likely review the comments on its policy proposals before issuing a final rule later this year.

Written by Amy Baxter

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