For the second year in a row, the Centers for Medicare and Medicaid Services (CMS) has widened the scope of supplemental benefits Medicare Advantage (MA) plans can offer, creating even more opportunities for home care providers to become partners in MA contracts. CMS is also giving the MA program a pay raise to help drive the expansion.
The 2020 rules from CMS, which were released Monday, give MA plans permission to cover benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions.
Of the nation’s $3.3 trillion in annual health care spending, 90% stems from people with chronic or mental health conditions, according to the Centers for Disease Control and Prevention.
The rules also allow for coverage of services tailored to individual patients.
While CMS has made several moves to broaden the MA program over the past year, the extent of the latest expansion is somewhat surprising, experts say. In fact, Anne Tumlinson — CEO and founder of Anne Tumlinson Innovations (ATI) — told Home Health Care News she was ‘pretty shocked’ by the move.
“The new guidance gives plans nearly as much flexibility as possible within the constraints of the law,” she said. “Said another way: I think that CMS has done everything it possibly can, within the constraints of the statute, to make the supplemental benefit flexible and easy for plans to administer.”
The benefit expansion comes after CMS added non-skilled in-home care as an MA benefit in 2019. Before that, supplemental benefits could only include services that were “primarily health-related.”
While the services an MA organization chooses to cover are discretionary, the new 2020 rules open the door for a number of non-medical services that address social determinants of health, or environmental factors that can affect people’s well-being.
Some examples include home modification, companion care, carpet cleaning and more.
“For the calendar year 2020, some of the plan challenges inherent in the calendar year 2019 plan year have been lifted, and you should see significantly more plans trying new things,” Tumlinson said. “This is about as optimistic a rule issuance as you could hope for.”
Tumlinson said home care providers should begin discussions with MA providers to take advantage of the benefits in their markets, noting, however, that they should also proceed into potential MA arrangements with caution.
“Supplemental benefit dollars is a small pot that also has to cover other supplemental benefits and out-of-pocket costs,” she said.
In addition to expanding MA benefits, CMS also OK’d a 2.53% payment raise for plans in 2020, nearly one full percentage point above the increase CMS originally projected in December.
In general, the rules for 2020 released by CMS on Monday match home care industry expectations for when real MA opportunities will begin to emerge in earnest. Although MA plans were able to offer certain in-home services and supports in 2019, not many chose to do so due to time constraints.
Most home care insiders have targeted 2020 and 2021 for the ramping up of MA business opportunities.