In early 2018, the Centers for Medicare & Medicaid Service (CMS) announced that non-skilled in-home care supports will be included as a supplemental benefit in Medicare Advantage plans in 2019. Medicare Part B (optional coverage) covers part-time or intermittent skilled nursing care and home health aide care. The care must be medically necessary.
WHY SHOULD YOU BE INTERESTED?
This supplemental benefit for daily maintenance will be available to Medicare Advantage plan participants. One in three people who are enrolled in Medicare have Advantage plans and there are roughly 19 million beneficiaries of Medicare Advantage plans. This policy enables supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” per the CMS announcement.
HOW CAN YOU PARTICIPATE?
Medicare Advantage (MA) plans are administered by insurance companies such as Humana, Aetna, Kaiser Permanente and others. If you wish to participate, reach out to the appropriate people at the MA plan offices that provide coverage in your service area regarding covering these services in 2019.
If the plans are not covering these services in 2019, you should be developing and presenting data that demonstrates the cost-effectiveness of your services in preventing or reducing ER and hospital utilization, to convince the plans to cover these services in 2020 and thereafter.
Your investment of time could pay off in another reliable source of funded clients.