Provisions in the February 1 Draft 2019 MA and Part D call letter could open the door for Medicare Advantage (MA) plans to begin covering services to support aging in place by expanding the definition of supplemental benefits.* Aging in place is defined as the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level. Over 90% of individuals age 65 and over, estimated to be 71.5 million Americans by 2030, indicate that they want to age in place. However, aging in place presupposes the coordination of a number of factors, predominant among them are health care, personal care services and social determinants of health.
While today Medicare pays for a limited number of in-home skilled care visits, it does not currently pay for those personal care services to support activities of daily living or home improvement initiatives needed to make the home environment safe. When these services are covered, they are paid for by Medicaid under state waiver programs or state plan amendments and, as such, are restricted by income requirements and often limited to certain categories of Medicaid beneficiaries.
State studies have repeatedly shown both cost and quality of life benefits of in-home care support services for the covered population which is predominantly dual eligibles. An AARP report on 38 state studies of HCBS concludes that "the studies consistently provide evidence of cost containment and a slower rate of spending growth as states have expanded HCBS". ** Furthermore, the studies found much lower per individual average costs for HCBS compared to institutional care.
The Bipartisan Budget Act (BBA 2018) also moved in this direction by defining benefits to chronically ill members that "have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits".
With these new CMS policies, MA plans have the opportunity to move beyond the rhetoric of social determinants of health and to take action with a supplemental custodial benefit that will enable seniors to remain in their home for as long as possible by providing supporting services to help with activities of daily living. The benefit would integrate with care coordination to reduce readmissions, improve quality and lower spend by supplementing home health services. Under the draft call letter, the benefit could be priced in the MLR calculation as a new benefit and would support member retention and growth. Today companies such as CareLinx, a nationwide firm with 250,000 caregivers, offer plans the necessary supportive data and technology to make personal care services an important part of a comprehensive care management strategy. As such, these services have the potential to reduce overall nursing home costs, avoid readmissions, increase member satisfaction, and improve outcomes.
For more information on the potential of a supplemental personal care benefit and potential design options, contact email@example.com.
* See Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies available at: https://www.cms.gov/Medicare/Health-plans/MedicareAdvtgSpecRateStats/Downloads/Advance2019Part2.pdf
** AARP Report, State Studies Find Home and Community Based Services to Be Cost-Effective, available at https://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2013/state-studies-find-hcbs-cost-effective-spotlight-AARP-ppi-ltc.pdf