![\"\"](\"https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/04\/Managedcare.png\")
<\/p>\n<\/p>\n
Key: Help show that aide services will \u2018reduce avoidable emergency and healthcare utilization.\u2019<\/em><\/strong><\/span><\/p>\n Exactly how much a new broadening of the Medicare Advantage benefit rules will affect home care providers remains unclear, but it looks promising.<\/p>\n The change:<\/span>\u00a0<\/strong>The\u00a0Centers for Medicare & Medicaid Services\u00a0<\/strong>has finalized a February proposal to allow MA plans to cover aide services under their supplemental benefits, according to an April 2 Part D rate announcement and call letter for 2019.<\/p>\n Aide services don\u2019t qualify for inclusion under CMS\u2019s current definition of a supplemental health care benefit allowed in regulation, because the definition precludes services for \u201cdaily maintenance,\u201d the agency notes in the letter. \u201cHowever, medical and health care research has demonstrated the value of certain items and services that can diminish the impact of injuries or health conditions and reduce avoidable emergency and health care utilization,\u201d CMS allows.<\/p>\n Therefore, \u201cCMS is expanding the scope of the primarily health related supplemental benefit standard,\u201d it explains in the 270-page letter. Regulations don\u2019t define the term \u201chealthcare benefits;\u201d thus, CMS has \u201cauthority to interpret the term more broadly than we have in the past, to permit MA plans to offer additional benefits as \u2018supplemental benefits\u2019 so long as they are healthcare benefits.\u201d<\/p>\n CMS now says to qualify as \u201cprimarily health related,\u201d a service \u201cmust diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional\/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization.\u201d The definition change \u201cwill allow MA plans more flexibility in designing and offering supplemental benefits that can enhance beneficiaries\u2019 quality of life and improve health outcomes,\u201d the agency concludes in the letter.<\/p>\n The change will take effect in 2019.<\/p>\n \u201cHome care services continue to demonstrate high value in all care delivery models, including managed care,\u201d\u00a0National Association for Home Care & Hospice\u00a0<\/strong>President\u00a0William Dombi\u00a0<\/strong>says. \u201cBy allowing Medicare Advantage plans to use caregivers in the home as a supplemental benefit, it can be expected that the plans will reduce overall care costs while improving patient outcomes.\u201d With MA participation at more than one-third of beneficiaries and rising, the change could be significant.<\/p>\n \u201cCaregivers can be very helpful in making care transitions successful, avoiding initial and rehospitalizations,<\/p>\n and spotting potential exacerbations in the patient\u2019s clinical condition,\u201d Dombi explains in the NAHC newsletter. \u201cThat happens because they are in home with the patient and capable of assisting with care plan adherence and observing changes in the patient\u2019s condition. If done correctly by the plans, this will be a very positive move by CMS.\u201d<\/p>\n Another provision in the call letter that may affect home care providers is new opioid drug-utilization review standards.<\/p>\n Note: See the call letter at\u00a0www.cms.gov\/Medicare\/Health-Plans\/MedicareAdvtgSpecRateStats\/Downloads\/Announcement2019.pdf<\/a>.<\/em><\/p>\n Source- SuperCoder<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Key: Help show that aide services will \u2018reduce avoidable emergency and healthcare utilization.\u2019 Exactly how much a new broadening of the Medicare Advantage benefit rules will affect home care providers … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":152,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15,5],"tags":[11,12,13,14],"class_list":["post-151","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-home-health","category-reimbursement","tag-home-care","tag-hospice","tag-ltc","tag-snf"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=151"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/151\/revisions"}],"predecessor-version":[{"id":153,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/151\/revisions\/153"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/152"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=151"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=151"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}