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Home Health Stakeholders Voice Their Concerns To CMS Over Medicare Advantage Program
Home Health Care News | By Joyce Famakinwa
Home health stakeholders – and many others – recently had the opportunity to weigh in on the way Medicare Advantage (MA) is currently administered by the U.S. Centers for Medicare & Medicaid Services (CMS).
The National Association for Home Care & Hospice (NAHC) and Moving Health Home are among the two groups that answered CMS’ request for information.
In July, CMS released that request for information seeking public comment on the MA program. Comments were to be submitted by Aug. 31, 2022.
“The significance is that CMS is beginning to evaluate the plans more closely in terms of provider relations and approaches to health care delivery for enrollees and how the plans can improve health care services for these beneficiaries,” Mary Carr, vice president of regulatory affairs at NAHC, told Home Health Care News in an email.
Broadly, the comment period gave home health stakeholders the opportunity to affect potential future rulemaking on various aspects of the MA program. This is notable because Medicare Advantage enrollment continues to grow — having more than doubled over the last decade.
In fact, Medicare Advantage has 28.4 million beneficiaries, or 45% of the Medicare population. By 2030, Medicare Advantage is expected to have over 52% of total Medicare enrollment, according to data from the research and advocacy organization Better Medicare Alliance.
With enrollment on the rise, it’s likely that providers will become even more entangled with health plans offering Medicare Advantage. And as this happens, it’s the responsibility of providers and plans to work together, NAHC President William A. Dombi wrote in the organization’s comments to CMS.
“It is imperative that the [MA] plans and the provider community work together to ensure patient-centered, high quality health care is provided to all beneficiaries,” he said.
This comment period is also significant because it gives home health stakeholders the floor to share their point of view. In the past, providers have been vocal about the challenges surrounding MA.
Specifically, providers have struggled with receiving fair rates for the services they deliver.
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House Passes Bill to Install Electronic Prior Authorization in Medicare Advantage Plans
Fierce Healthcare | By Robert King
The House passed key legislation that creates an electronic prior authorization process for Medicare Advantage (MA) plans and other reforms aimed at a major headache for providers.
The House unanimously passed the Improving Seniors’ Timely Access to Care Act on Wednesday via a voice vote. The legislation, which has new transparency requirements for MA plans, now heads to the Senate.
Lawmakers behind the legislation said in a joint statement the bill will “make it easier for seniors to get the care they need by cutting unnecessary red tape in the healthcare system,” said Reps. Suzan DelBene, D-Washington, Mike Kelly, R-Pennsylvania, Ami Bera, M.D., D-California, and Larry Bucshon, M.D., R-Indiana.
Prior authorization—where providers must first get insurer approval before performing certain services or making prescriptions—has increased in recent years much to the chagrin of providers who charge the process causes a massive administrative burden.
The House bill aims to require the establishment of an electronic prior authorization process for all MA plans to hasten the approval of requests. It would also require the Department of Health and Human Services (HHS) to create a process for faster, “real-time” decisions on the items or services that already get routinely approved.
Another new requirement is that MA plans must report to the federal government on how they use prior authorization, as well as the rate that such requests are approved and denied. The requirement comes as HHS’ watchdog found that MA plans have denied prior authorization claims for services that met Medicare’s coverage requirements.
The overwhelming House vote earned plaudits from several provider groups.
“At a time when group practices face unprecedented workforce shortage challenges, 89% of [Medical Group Management Association] members report they do not have adequate staff to process the increasing number of prior authorizations from health insurers,” the Medical Group Management Association said in a statement. “By streamlining and standardizing the overly cumbersome and wildly inefficient MA prior authorization process, this legislation will return a focus to the physician-patient relationship.”
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A Brief Explainer on the Preserving Access to Home Health Act
Home Care Magazine | By Kristin Easterling
HR 8581/S 4605
The annual proposed rule for Medicare home health services, which the Centers for Medicare & Medicaid Services (CMS) released in June, includes an estimated 4.2% or $810 million decrease in aggregate payments. The rule would apply to calendar year 2023.
An analysis of the rule from the National Association for Home Health & Hospice (NAHC) revealed that 44% of home health agencies would operate at a loss in 2023 if the rule moved forward as proposed. The home health industry reacted strongly to the news and jumped into action to halt the proposed cuts.
“The stability of home health care is at risk because of CMS proposing the application of a fatally flawed methodology for assessing whether the Patient Driven Groupings Model led to budget neutral spending in 2020 and later years,” said William A. Dombi, president of NAHC.
“In its actions, the administration is undermining providers’ ability to deliver these critical services. … CMS is unfairly assuming all providers are bad actors. This is not acceptable,” said Katie Smith Sloan, president and CEO of LeadingAge.
“Considering that access to home-based care has become increasingly important to the health and safety of American seniors, it is very troubling that CMS would propose such steep rate cuts for next year and potentially even deeper cuts in the future,” said Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare.
In late July, Sens. Debbie Stabenow (D-Michigan) and Susan Collins (R-Maine), introduced the Preserving Access to Home Health Act. A House version of the bill soon followed, initially sponsored by Rep. Terri Sewell (D-Alabama).
If passed, the act would freeze current Medicare reimbursement rates for home health through 2026, but requires any make-up payments discovered then to be paid by 2032 in order to keep everything within the current 10-year budget cycle. It focuses solely on the payment issue, not on other adjustments in the proposed rule. The bill is designed to be budget neutral.
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MedPAC Explores Standardized Plan Options in Medicare Advantage
Fierce Healthcare | By Robert King
Affordable Care Act (ACA) plans may not be the only ones to introduce standardized options, as a key advisory panel wants to apply a similar strategy to the popular Medicare Advantage (MA) program.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues, is researching how standardized benefit options would work for MA. The goal is to include the findings in an annual report to Congress next year and explore how standardization could help simplify choice for seniors.
“I think there’s some reasonable evidence about the challenges of choice,” said Michael Chernew, the commission chair, during the panel’s Thursday meeting.
MA plans are required to offer services under Medicare Parts A and B, but there are some differences based on cost-sharing and other supplemental benefit packages. The MA program has gained in popularity in recent years and with it an abundance of plan choices for seniors.
Commission staff gave an example of how standardized benefit packages work by breaking out three options based on how generous they were for cost-sharing. What types of plans would be subject to the standard package would have to be decided and could be vital.
“This requirement would aim to ensure a minimum level of access to standardized plans, but its impact could be limited if the plans that insurers are required to offer are unpopular,” said MedPAC staff member Eric Rollins.
Letting insurers offer both nonstandardized and the standard options could also help reduce any disruption for existing enrollees but could reduce any gains from standardization, he added. Only offering the standardized benefit plans, on the other hand, could cause too much disruption.
There could be a benefit to insurers, though, by avoiding paying a broker that guides seniors through different plan options.
“There’s a huge financial incentive for them,” said commission member Lynn Barr.
However, some commission members were concerned about the impact standardization could have on plan innovation.
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Home Health Referrals Skyrocketed, Patients Became More Complex During Pandemic
Home Health Care News | By Patrick Filbin
As predicted by many at the onset of the pandemic, home health providers gained a larger share of post-acute referrals in recent years than they did prior to COVID-19.
At the same time, data shows that patients coming to post-acute care are sicker and have more complicated care needs than before, all while staffing shortages continue to put a strain on home health agencies.
A new report from the post-acute technology company WellSky shows that by May 2022, home health referrals were at 123% of what they were in 2019.
The COVID-19 emergency added value to, and demand for, home-based care delivery. The industry should expect that demand to stick.
“As you start to bring to bear science on the discharge dynamic, you will continue to see a growing number of patients moving into home-based care settings,” Tim Ashe, chief clinical officer at WellSky, told Home Health Care News. “Complex care plans can be safely delivered effectively and efficiently at home.”
Referrals staying near 123% of 2019 might not be a realistic expectation, Ashe said. But now that the industry is removed from the worst of the pandemic, there is still plenty of room for growth.
“I don’t know what the growth rates are going to be, but I personally anticipate continued growth,” Ashe said. “That’s going to take some investments in the infrastructure across the home health industry. How do we make sure the tide is rising so that all providers can provide care at scale to complex patients?”
One of those solutions could be the Choose Home Care Act of 2021, a piece of legislation that — among other things — supports in-home care alternatives to skilled nursing facilities (SNFs).
The bipartisan bill is currently in limbo in Washington D.C., but would be a vehicle of relief for SNFs and a boon for home health agencies.
That’s particularly relevant given the WellSky report also found that during the first quarter of 2022, referral rate rejection among home health referrals climbed to 71% due to a lack of staff.
“That’s a direct result of staff capacity,” Ashe said. “Those rejection rates are concerning. It goes back to enabling the industry to scale and incent professional and paraprofessional care providers to come into the industry because it is a really attractive space. We just need to solve some of those economic and potential safety issues that I think were highlighted during the pandemic.”
Even if home-based care demand rises, without the corresponding staff capacity, that demand could be all for naught.
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