CMS Announcement May Create More Medicare Advantage Opportunities for Home Care Providers

Non-medical home care providers hoping to break into the Medicare Advantage (MA) space have been attentively watching for signs of how plans will respond to the coronavirus.

While some believe the COVID-19 virus will throw a wrench into MA home care opportunities, others believe the current public health emergency will only accelerate plans pushing into the home and shifting toward social determinants of health.

“There can be little doubt that there is some slowing in innovation on what providers can do to be ready [for MA],” Jeff Wiberg, CEO of Family Resource Home Care, recently told Home Health Care News in an email. “That being said, crises like COVID-19 can certainly be an opportunity to exemplify the role that home care can play in managing patients who may have used more expensive acute settings for dealing with their issues and who have been incentivized to stay home recently.”


Headquartered in Washington state, Family Resource is a large regional non-medical home care company that provides personal care services and activities of daily living (ADL) support.

Thanks to new guidance issued by the U.S. Centers for Medicare & Medicaid Services (CMS) last week, it now appears that plans are well-positioned to double down on in-home touchpoints with members.

On April 24, CMS announced it was allowing plans to provide mid-year benefit enhancements in response to the COVID-19 outbreak.


“CMS is exercising its enforcement discretion to adopt a temporary policy of relaxed enforcement in connection with the prohibition on mid-year benefit enhancements, such as expanded or additional benefits, when such mid-year benefit enhancements are provided in connection with the COVID-19 outbreak, are beneficial to enrollees and are provided uniformly to all similarly situated enrollees,” the agency wrote in a letter to Medicare Advantage organizations.

The Washington, D.C.-based Better Medicare Alliance (BMA) is among the MA stakeholders that supported the move.

BMA itself had advocated for mid-year benefit flexibility in an April 3 letter to CMS.

“Even before the height of coronavirus, more than two-thirds of Medicare Advantage plans provided access to remote access technologies like telehealth, while roughly half offer meal benefits that can help meet seniors’ nutritional needs while keeping them safe at home,” Allyson Y. Schwartz, president and CEO of BMA, said in a Friday press release. “This guidance ensures that Medicare Advantage can take further steps to meet beneficiaries’ needs in these unprecedented times, including expanded use of new technologies by beneficiaries from their homes.”

Overall, there are about 67.7 million Medicare beneficiaries in 2020, according to statistics from the Kaiser Family Foundation. Of those, about 24.1 million individuals — about 36% of all beneficiaries — are enrolled in MA plans.

Currently, most MA enrollees have access to supplemental benefits not offered in traditional fee-for-service Medicare. CMS first expanded the scope of what plans can offer in 2018 for the 2019 plan year, then did so again in 2019 for the 2020 plan year.

It was these two rapid-fire expansions that set the scene for non-medical home care under Medicare Advantage.

Just 4% of 2020 MA enrollees are signed up for plans that cover in-home support, according to Kaiser Family Foundation. While that may be the clearest MA entrance for home care, a much larger share of MA enrollees are signed up for plans that cover secondary services often delivered by providers.

For example, 34% of 2020 MA enrollees are in plans with transportation benefits, while 39% are in plans with meal benefits.

Perhaps most relevant to the coronavirus conversation: 77% of MA enrollees have a telehealth benefit in 2020.

Anthem Inc. (NYSE: ANTM) and a number of its affiliated health plans are among the MA entities to offer home care-related supplemental benefits in both 2019 and 2020. Others include Cigna (NYSE: CI), Humana (NYSE: HUM) and SCAN Health Plan.

“We recognize that beneficiaries that experience limitations in [ADLs] are at … greater risk for a fall, greater risk of social isolation and more likely to have access-to-care issues,” Martin Esquivel, VP of product management and strategic initiatives for Anthem, previously told HHCN. “Helping create a stable, safe environment in the home, we see that as a first step toward helping beneficiaries down a path toward a more comfortable, sustainable health care experience.”

Although there are still questions regarding CMS’s mid-year benefit flexibility and how long it will last, the coronavirus will likely push more MA players into innovative, home-focused supplemental benefits sooner rather than later.

“I see good things on the horizon for home-based care as a result [of the national coronavirus response], but it may take some time for the dust to settle,” Wiberg said.

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