Medicare and Private Duty Home Care – Finally

Reprint from Home Health News

Direct Care Training & Resource Center, Inc.Non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019, the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday.

The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage.

“CMS is expanding the definition of ‘primarily health related,” the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

The rule was originally proposed in February and was met with enthusiasm from the home health and private duty home care industries. Home health care providers have already made great strides as partners in MA contracts, and adding non-skilled services opens the door to the growing MA population even further.

In 2015, 35% of Medicare beneficiaries were participants in MA, according to CMS data. And that figure is expected to grow quickly over the next several years.

Home care providers are not the only ones welcoming this change, as many also believe MA payors are ready and willing to pay for non-skilled in-home care services.

“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group Elevating Home, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibilities than the fee-for-service providers do. They don’t have a homebound requirement in many cases. So, they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”

In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.

Even before today’s final rule, some providers have been positioning themselves to take on more personal care, with an eye toward MA trends.

“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve have a great relationship for skilled home health and hospice for quite a while,” Keith Myers, CEO of LHC Group (Nasdaq: LHCG), told HHCN. “In the last few years, they’re starting to focus more on dual-eligible population and have needed us to have a bigger commitment in personal services.”

With the merger of Almost Family closed as of April 1, LHC Group sees itself as having a big advantage to add in-home care supports to its MA contracts.

“[With] Almost Family, many people don’t know that they started 40 years ago as a personal care services business,” Myers said. “So they have a long history of personal care services and are second to no one with recruiting, retention, and managing those type of employees. We want to leverage that.”

We would love to have your comments.

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Note: Direct Care Training & Resource Center, Inc. is a private organization that provides training and assistance to community care providers and prospective providers in matters of continuing education, business development assistance and general information workshops. We are not regulators.  We do not seek to replace regulators. We are not competitors of regulators.  Neither do we recommend a provider of care or prospective provider of care ignore the advice and direction of regulators.  This is not our role.  Additionally for those we assist with accreditation please remember this is a collaborative process that takes times.  Step-by-step we will lead and require your input and cooperation.  Many of our training workshops are approved as continuing education units for adult foster care group home licensees and administrators, personal care homes, adult family care homes and other assisted living models. As such, many of our training products do incorporate the review of regulatory statutes, administrative rules and laws that pertain to the provision of care, all of which is readily available to the general public. We are not a governmental entity and our programs must never be viewed as a replacement or substitute for State or federally sponsored orientations, licensing preparatory meetings or any other government sponsored or governmentally mandated educational event or training. Additionally, approval for continuing education courses does not in any way constitute a governmental endorsement of other services provided by our company or any of its affiliates.  Furthermore, attendance at any of our live sessions, use of our self-study materials or online/virtual school and any technical assistance we may offer must never be viewed as a guarantee of potential business success, elimination of liability or specific financial gain. It is the responsibility of the individual business owner to work toward and create a pattern of success for his/her business entity.  While we make a concerted effort to offer quality advice and teach providers the highest levels of quality customer service, clients must not look to our company to ensure they are successful as community-based care providers.  We cannot guarantee how long it will take to attract clients or residents and we will not assure a particular lifestyle from your business efforts. Please note that licensed adult foster care group homes in Michigan who have contracts with community mental health agencies may be obligated to receive all direct care worker and medications training through that agency or the training organization they specify.  Check with them before calling our company to enroll in training programs. 6% sales tax charged on all self-study products in the State of Michigan.  Information provided in our workshops is up-to-date and accurate to the best of our knowledge and belief.  Sample forms used in live training sessions and the online/virtual school may bear the name of certain waiver agents but must in no way be interpreted as an implied endorsement by any agency or governmental department.  If a live class paid for is missed, no cash refunds will be made, however a credit will be issued allowing you to attend a comparable event within one year of payment.

 

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