When the Centers for Medicare & Medicaid Services (CMS) announced it would allow Medicare Advantage (MA) plans to cover certain non-medical home care services in 2019, interest was tepid, with only 3% of plans actually covering those benefits.
So it is no surprise that a subsequent expansion for 2020 brought questions about just how much of an impact additional changes will have.
But according to new data from a Home Health Care News survey of 105 providers of at-home services and supports, the impact will be significant: 90% of respondents anticipate contracting with an MA plan for the 2020 plan year, compared to only 59% of respondents that are currently contracted with an MA plan.
The CMS MA expansion puts a new focus on using in-home services to help seniors living with chronic illnesses, calling these benefits Special Supplemental Benefits for the Chronically Ill. While the expansion’s goal is specific, the techniques are broad: CMS gives MA plans creative leeway to cover benefits that “have a reasonable expectation of improving or maintaining the health or overall function” of these seniors.
These can include non-medical, in-home services that improve social determinants of health, such as personal care, telehealth or housekeeping. In essence, the new rules give home care providers increased flexibility to experiment with proactive services that can help chronically ill seniors remain healthy — and out of the hospital.
“No one has been able to quantifiably show in a peer-reviewed journal … exactly how addressing social determinant factors of health provides strong ROI and returns,” CEO Sherwin Sheik of online care platform CareLinx told HHCN in April. “With the language of ‘have a reasonable expectation of improving,’ what CMS is doing is allowing health plans to really experiment.”
That vague language led to many providers believing the MA boom for home care would come in 2021, not 2020.
“(MA) is a tremendous opportunity and a tremendous recognition of the value that personal care or home- and community-based services can contribute in better outcomes while caring for chronically ill people,” Addus HomeCare Corporation (Nasdaq: ADUS) Chief Development Officer Darby Anderson said in April on a panel at HHCN’s Capital + Strategy Forum. “But it’s going to be slow to materialize.”
Instead, HHCN’s survey results suggest opportunities may be even greater than previously anticipated, with a third of respondents pouncing on the MA opportunity for 2020 after not doing so this year.
“We want to be engaged with the MA plans early in order to help inform the expectations of a home care partner to be able to demonstrate value to the plan and their enrollees, and in return for home care providers to be able to expect fair requirements and reimbursements from the plans,” Jennifer Ramona, Homewatch CareGivers vice president of strategy and health care innovation, told HHCN in April. “We are not waiting for 2021.”
MA plans typically submit their bids to CMS in June. The official enrollment period starts Oct. 1.
To learn how you can participate in future HHCN surveys, subscribe to the HHCN email, here. Read part 2 in our HHCN – Medicare Advantage survey: “Personal Care Services Projected to Dominate Home Care’s 2020 Medicare Advantage Involvement.”