CMS Outlines Further Expansion of Medicare Advantage Benefits for In-Home Services, the Chronically Ill

The Centers for Medicare & Medicaid Services (CMS) is proposing to further expand Medicare Advantage (MA) flexibilities for certain in-home services and supports for chronically ill Americans starting in 2020, the agency announced Wednesday.

The move is in line with CMS’ larger goals of broadening the scope of the MA program, which has quickly grown in popularity over the past several years.

Specifically, the newly proposed changes will help older adults and chronically ill individuals pick plans that are more closely catered to their health needs, according to CMS. Federal policymakers previously announced they were providing new supplemental benefits and flexibilities for the 2019 plan year last April.

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“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” CMS Administrator Seema Verma said in a statement. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

In the past, MA plans have only been allowed to offer primarily health-related supplemental benefits uniformly to all enrollees.

Beginning with the 2019 plan year, CMS determined that plans can provide certain enrollees with access to different benefits and services, including home-delivered meals and certain non-medical in-home care.

The rule change marked a major shift for home care agencies that typically operate on a private-pay model, with some adjusting their strategies and refining data-collection efforts to win Medicare Advantage business in years ahead. This latest announcement from CMS provides yet another reason for home care providers to continue down that road.

CMS’ proposal is linked to the Bipartisan Budget Act of 2018, which amended rules and regulations to allow MA plans to offer non-primarily health-related supplemental benefits to chronically ill enrollees come 2020.

The act also allowed CMS to waive uniformity requirements with respect to supplemental benefits for chronically ill individuals.

To be defined as chronically ill, MA enrollees must meet three conditions.

They must have one or more co-morbid and medically complex chronic conditions that is life-threatening or significantly limits overall health function. They must additionally have a high risk of hospitalization or other adverse health outcomes, while also requiring intensive care coordination.

Those requirements generally describe the client population of most home care agencies, perhaps suggesting great-than-anticipated MA opportunity moving forward.

MA organizations have broad discretion in developing items and services they may propose as supplemental benefits for the chronically ill, so long as the item or service has a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to their chronic disease, according to CMS. Such items and services may not include capital or structural improvements to the home of the enrollee that could potentially increase property value, however.

CMS is taking comments on its proposal until March 1, 2019.

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