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Medicare Advantage Plans adding Home Care Benefit in 2020

Medicare Advantage Plans May Provide Additional Supplemental Benefits in 2020

On April 27, 2018, the Medicare Drug and Health Plan Contract Administration Group of the Centers for Medicare and Medicaid Services (CMS) issued a memo to Medicare Advantage (MA) Plans about reinterpretation of the definition of "primarily health related" for the purposes of providing supplemental benefits to enrollees. Beginning in CY 2019, CMS expanded the definition of "primarily health related" to include items or services if they are used to:

  • Diagnose or compensate for physical impairments

  • Ameliorate the functions/psychological impact of injuries or health conditions, or

  • Reduce avoidable emergency and healthcare utilization

The guidance in this memo was incorporated into the Medicare Managed Care Manual, Chapter 4.

On April 1, 2019, CMS issued a "2020 Medicare Advantage and Part D Rate Announcement and Final Call Letter" that includes final policy and payment updates to Medicare Advantage (MA) Plans for 2020. With regard to special supplemental benefits for the chronically ill, CMS says in its Letter that the Bipartisan Budget Act of 2018 (Public Law No. 115-123) amended the statute to allow MA Plans to offer non-primarily health-related supplemental benefits to chronically ill enrollees. The law also allows the Secretary of the U.S. Department of Health and Human Services (HHS) to waive uniformity requirements that will allow MA Plans to vary supplemental benefits based on individual chronically ill enrollees' specific medical conditions and needs.

In the final Call Letter, CMS provides guidance about these new special supplemental benefits for the chronically ill. Generally speaking, MA Plans will have greater flexibility to offer chronically ill patients a broader range of supplemental benefits that are tailored to their specific needs. Examples include provision of meals beyond a limited period of time, transportation for non-medical needs, such as grocery shopping, and home environmental services.

These benefits must, however, have a reasonable expectation of improving or maintaining the health or overall function of patients related to their chronic conditions or illnesses. For patients with asthma, for example, MA Plans may cover home air cleaners and carpet shampooing to reduce irritants that may trigger asthma attacks. Diabetic patients may receive coverage for the services of nutritionists.

The final Call Letter also says that CMS is giving MA Plans a rate increase of 2.53% that may help Plans pay for the expansion of benefits in addition to costs saved as a result of better management of chronic conditions.

The 2020 Rate Announcement and Call Letter can be viewed at: by selecting "2020 Announcement."

This expansion gives home care providers of all types the opportunity to partner with MA Plans in the care of chronically ill patients. Home care providers will make great partners for MA Plans as they offer supplemental benefits to chronically ill enrollees because if any group of providers understands so-called social determinants of health, it is certainly home care providers!

Collaborating with MA Plans may, however, be rocky for home care providers at first. It looks like private duty agencies, for example, are especially well-positioned for such partnerships. Anecdotally, however, some MA Plans have apparently told private duty agencies that they will partner only with home health agencies that are Medicare certified. MA Plans don't quite know how to work with home care providers yet, but, with help, they can learn for the benefit of patients.

©2019 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

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