CMS to Allow Non-Skilled Home Care Benefit in Medicare Advantage

Feb 6, 2018

  1. Brian Anderson
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    Brian Anderson Executive Editor

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    Bad news for LTCI? Tipped off about this by Ron Iverson's NAMSMAP newsletter today.

    On Feb. 1, CMS released proposed changes for the Medicare health and drug programs in 2019 that increase flexibility in Medicare Advantage that will allow more options and new benefits to Medicare beneficiaries...

    From the CMS release (link below):
    As a part of these changes, CMS is redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them.
    “Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”
    CMS has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy announced today, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.


    So CMS is going to start allowing MA plans to offer some LTCI-type benefits?

    2018-02-01 - Centers for Medicare & Medicaid Services
     
  2. somarco
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    somarco That Medicare Guy

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    I would presume these same benefits will be extended to original Medicare, which means they would spill over to Medigap.
     
    somarco, Feb 6, 2018
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  3. yankee466
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    yankee466 Guru

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    Well...if Medicare is already broke, why not get it to cover more stuff? :-)

    Bringing in a home health care agency today for 8 hours a day 5 days a week is only $30-40K per year...hence the need for HHC coverage in a LTC policy.

    I'd imagine there is enough fine print exclusions in this proposal to not have people dropping their LTC policies any time soon. LTCi insurance buyers are also generally not Medicare Advantage clients.

    Maybe they are bringing the Class Act again....and we all know how that went.
     
  4. Mr_Ed
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    2018-02-01 - Centers for Medicare & Medicaid Services[/QUOTE]
    No. The benefits that Brian is referring to will only be available to some of the participants of Medicare advantage plans. These benefits will not be extended to original Medicare.
     
    Mr_Ed, Feb 10, 2018
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  5. somarco
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    somarco That Medicare Guy

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    The operative phrase here is "will be" . . . as in possibly in the future

    How is Wilbur?
     
    somarco, Feb 10, 2018
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  6. Mr_Ed
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    The "supplemental benefits" in the Chronic Care Act will not even be available to every MA enrollee. The MA's will have the option to choose which areas and patient groups will get these supplemental benefits. The supplemental benefits are NOTHING like what a long-term care policy provides.
     
    Mr_Ed, Feb 10, 2018
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  7. Mr_Ed
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    Mr_Ed, Feb 10, 2018
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  8. Mr_Ed
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    Here's the law's definition of the supplemental benefits that MA plans may now include:

    ‘‘(I) IN GENERAL.—Supplemental
    benefits described in this clause are
    supplemental benefits that, with
    respect to a chronically ill enrollee, have
    a reasonable expectation of improving
    or maintaining the health or overall
    function of the chronically ill enrollee
    and may not be limited to being
    primarily health related benefits."
     
    Mr_Ed, Feb 10, 2018
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  9. Mr_Ed
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    Mr_Ed, Feb 10, 2018
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  10. Mr_Ed
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    The whole idea behind Medicare Advantage plans, Brian, is to slow the growth of federal spending on Medicare, not accelerate it.

    In 2014, the average long-term care daily benefit was $138 and the average benefit period was 5.3 years. Do you think adding $50,000 per year of custodial care to a Medicare Advantage plan is going to reduce the growth of Medicare? Adding that kind of benefit to Medicare Advantage plans would destroy the program.


    sao
     
    Mr_Ed, Feb 10, 2018
    #10