A New Biden Proposal Would Make Changes to Advantage Plans for Medicare: What to Know

USA TODAY | By Maureen Groppe

WASHINGTON − The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.

“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra.

If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs.

Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans.

Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

Here’s what you need to know.

Extra Medicare Benefits

Nearly all Medicare Advantage plans offer extra benefits such as eye exams, dental and fitness benefits. They’re offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services.

But enrollees use of those benefits is low, according to the Centers for Medicare and Medicaid Services.

To prevent the extra benefits serving primarily as a marketing ploy, the government wants to require insurers to remind seniors mid-year what’s available that they haven’t used, along with information on how to access the benefits.

“The rule will make the whole process of selecting a plan and receiving additional benefits more transparent,” Becerra said.

Broker Compensation Limits

Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. Officials said the change would also help reduce market consolidation.

“Some large Medicare Advantage insurance companies are wooing agents and brokers with lavish perks like cash bonuses and golf trips to incentivize them to steer seniors to those large plans,” said Lael Brainard, director of Biden’s National Economic Council…

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2023 RIHC Home Care Chartbook, Co-Sponsored by NAHC

The Institute is excited to announce the 2023 RIHC Home Care Chartbook is now available online! 

Highlighted by data on Medicare Advantage home health patients, workforce trends, and more, the Chartbook is an invaluable tool for understanding the role home care plays in the U.S. healthcare landscape. 

Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by KNG Health Consulting LLC, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS. 

We would like to thank 2023 Chartbook sponsor NAHC for their continued support of the Institute and the Chartbook. Learn more about NAHC at www.nahc.org.

A copy of the 2023 RIHC Home Care Chartbook is available here. 

Please join us for a webinar with the team from KNG, along with our co-sponsors at NAHC, on Wednesday, December 6th at 2 pm ET. Register now here.

For more information on the Chartbook, please reach out to the Institute's Executive Director, Jen Schiller, at [email protected] or (771) 203-0595.

Practice Committee Publishes New Medication Reconciliation Resource

Medication reconciliation is an important aspect of the initial and ongoing assessment for a patient receiving home health physical therapy. Medication reconciliation refers the process of creating the most accurate list of all medications a patient is taking, including drug name, dosage, frequency, and route and comparing that list against the admission, transfer, and/or discharge orders, with the goal of providing a correct list of medications to the patient at all transition points. Medication discrepancies frequently occur during care transitions from hospital to home. These discrepancies place patients at risk for adverse drug events (ADEs). Medication reconciliation is essential in managing adverse drug events and improving drug safety in older adults. It can be difficult to obtain a complete list of medications from a home health patient, and accuracy is dependent on the patients or caregiver’s ability and willingness to provide this information.

The “Medication Reconciliation in Home Health Physical Therapy” resource covers challenges in home health in reconciling medications, gives tips questions to ask patients and care givers to enhance the reconciliation process, and reviews methods to breaking barriers to medication reconciliation in home health.

Click Here to Download Resource

CMS Final Rule Reins in 2024 Rate Reduction, But Brings Big Cuts Beyond

HomeCare News

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) issued its 2024 Home Health Prospective Payment System Rate Update final rule on Nov. 1, landing on more moderate cuts than initially proposed but still enacting rate reductions beginning in 2025 that would present “serious concerns for the home health community,” according to the National Association for Homecare and Hospice.

The final rule calls for a -2.890% permanent adjustment in payment rates to home health agencies in calendar year 2024, half of the full permanent adjustment of -5.779%. The proposed rule called for a slightly lower overall permanent adjustment of -5.653%. CMS said that because the new rule only calls for half of the full permanent adjustment to go into effect in 2024, Medicare payment to home health agencies will increase by .8%, rather than the original 2.2% decrease initially proposed.

“This halving of the permanent adjustment is in response to commenter concerns about the magnitude of a single-year significant payment reduction,” CMS wrote in its announcement of the rule. “CMS will have to account for the remaining permanent adjustment not applied in CY 2024, and other potential adjustments needed to the base payment rate, to account for behavior change based on analysis at the time of future rulemaking.”

But NAHC said the cuts would still come to 6.533% over 2023 and 2024—with more to come in future years.

“We continue to strenuously disagree with CMS’s rate-setting actions, including the budget neutrality methodology that CMS employed to arrive at the rate adjustments,” said NAHC President Bill Dombi. “We recognize that CMS has reduced the proposed 2024 rate cut. However, overall spending on Medicare home health is down, 500,000 fewer patients are receiving care annually since 2018, patient referrals are being rejected more than 50% of the time because providers cannot afford to provide the care needed within the payment rates, and providers have closed their doors or restricted service territory to reduce care costs. If the payment rate was truly excessive, we would not see these actions occurring.”

“The fatally flawed payment methodology that CMS continues to insist on applying is having a direct and permanent effect on access to care,” Dombi continued. “When you add in the impact of shortchanging home health agencies on an accurate cost inflation update of 5.2% over the last two years, the loss of care access is natural and foreseeable.”

NAHC is currently suing CMS, saying the basis for its payment assumptions is flawed, and also pushing Congress to pass the bill S 2137, which would block the final rule.

“We now implore Congress to correct what CMS has done and prevent the impending harm to the millions of highly vulnerable home health patients that depend and will depend in the future on this essential Medicare benefit,” Dombi said. “We urge the Congress to support this bill and enact it into law before the end of the year. The 2024 rate cuts must not take effect” Dombi added.

The new rule also finalizes CMS’s proposals to:

• Rebase and revise the home health market basket
• Revise the labor-related share
• Recalibrate case-mix weights under the Patient-Driven Groupings Model (PDGM)
• Update low utilization payment adjustment thresholds, functional impairment levels and comorbidity adjustment subgroups for 2024
• Codify statutory requirements for disposable negative pressure wound therapy
• Establish payment rules for lymphedema compression treatment and home intravenous immune globulin

The rule also updates requirements for how often and when providers of durable medical equipment prosthetics, orthotics and supplies (DMEPOS) must contact beneficiaries before dispensing resupply items…

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Find the final rule at: https://www.federalregister.gov/public-inspection/2023-24455/medicare-program-calendar-year-2024-home-health-prospective-payment-system-rate-update-quality

Read a fact sheet on the rule at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-home-health-prospective-payment-system-final-rule-cms-1780-f