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The Expansion of Home Care Services Possible under Medicare Advantage – One More Way Accreditation Can Work for You

In the past few weeks one focus of care industry discussion has been the CMS approval of expanded home care services by Medicare Advantage plans.  The opportunity associated with this expansion deserves more detail than generally provided, it is not a “slam dunk” for home health providers.
Currently, MA plans must provide the same benefits as available under Medicare FFS, such as home health. Any additional services offered to beneficiaries are paid for by the MA plan from the CMS per member per month payments and/ or by a modest charge to the beneficiary.  

The new benefit approved for MA plans to offer and to consider in their premiums can include care, services or equipment to prevent an illness, compensate for functional impairments, address the psychological effects of illness or injury, and reduce ER use.  
As home-based providers, you know that Medicare home health patients are often discharged from services with continuing needs of multiple chronic condition management and aging that cannot be addressed due to the limitations of the home health benefit.  The range of services approved for MAs offers beneficiaries a means to meet these needs with the goal of reducing their overall cost of care over time.

Examples of likely services illustrate what we as clinicians know are common ongoing needs of elder beneficiaries who want to continue living safely at home.

Examples of services that could be covered include:
Access to healthy food, including home delivered meals
Transportation to medical appointments
Mobile dental clinics
Low cost hearing aides
Uncomplicated home modifications such as grab bars in the bathroom, and
Aide level services to help with daily activities including dressing, bathing, etc.

The CMS approval allows the MA plan to consider the cost of such support in the premiums and to market MA plans offering such services at the next open enrollment for 2019.  Not all MA plans may offer these services, but those that do will need providers. No current provision exists that these providers be Medicare certified.  However, health plans traditionally have network requirements and will have expectations of providers of these services. These health plans are most often NCQA (National Committee on Quality Assurance) or URAC accredited and they expect external review and oversight of network providers.

If you are a currently accredited home health agency with private duty services included in the scope of your accreditation, or an accredited private duty agency, you bring strong credentials to the table for MA contracting for these types of services.  
You have undergone review using national standards
That review involved experienced professionals on-site at the organization interviewing staff, reviewing policies and procedures and your organization’s implementation, as well as home visits to individuals receiving your services. 
Accreditation means a demonstrated commitment to meeting national standards in the delivery of these services.  

Next step is to watch for the announcement of MA plans in your area during open enrollment this Fall and note which offer these benefits. Or meet with Plans in 3rd quarter and present your accreditation and interest to be a provider.  Currently MA plans are preparing their submission of designated geographic areas to offer coverage, the scope of services to be offered and premiums for CMS approval. 

If you need more detail on the review of private duty services under accreditation to respond to AM plan network needs, let your Director of Accreditation know, or e-mail me at Make your team’s achievement of accreditation continue to distinguish you in your market. 


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