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Medicare Advantage to Cover Non-Skilled In-Home Care

On Mon., April 2nd, the Centers for Medicare and Medicaid Services (CMS) issued a final rule announcing that non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans in 2019.

The benefit marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. The agency states: “Previously, CMS has not allowed an item or service to be eligible as a supplemental benefit if the primary purpose includes daily maintenance. However, in the final Call Letter, CMS discusses a reinterpretation of the statute to expand the scope of the primarily health-related supplemental benefit standard. Under this reinterpretation, CMS would allow supplemental benefits if they are used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization. This expansion will effectively increase the number of allowable supplemental benefit options and provide patients with benefits and services that may improve their quality of life and health outcomes.”

The rule was originally proposed in February and was welcomed by the home health and private duty home care industries. For the full announcement on the Medicare Advantage policy changes, click here.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871