Beginning in 2019, Medicare Advantage plans may allow home care/personal care services as a supplemental benefit, according to a final rule issued by CMS. This would signify the first time CMS has permitted supplemental benefits that include daily maintenance in Medicare Advantage plans.
According to the CMS announcement:
“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.”
This rule was proposed back in February and earned the support of many industry stakeholders.
Over one-third of all Medicare beneficiaries are in Medicare Advantage plans and some home health services have been covered by those plans. Most industry observers expect the Medicare Advantage share of Medicare beneficiaries to grow, so allowing more home care services within the plans is a real win for the patients and providers.