Physician + Specialty Practices

The future of Medicare Advantage: home health and hospice provider spotlight

Part two in our guide to the changes coming to Medicare Advantage in 2021. Click here for part one.

With Medicare Advantage enrollment continuing to rise and more plans offering more benefits than ever, big changes are coming in 2021. In this part of our coverage, home health and hospice providers can find key changes to Medicare Advantage plans in the next year and advice on how to navigate billing and reimbursement concerns.

MA plans tend to be more transient, meaning patients may switch often, even yearly if they choose through the Open Enrollment period (January 1 through March 31, 2021). Providers must better manage every patient accordingly so they can maximize plan benefits. Doing so takes more effort, but the payoff can lead to stronger revenue.

Enrollment costs are down and more plans than ever are offering new, innovative benefits. But what does this mean for home health and hospice providers?

Updates for Home health and Hospice providers

Medicare Advantage is an important consideration for in-home care providers attempting to move away from fee-for-service Medicare. With the coming year’s general rise in MA enrollment and drop in premiums, new data from CMS reveal a massive expansion of the supplemental benefit programs that will benefit home care providers.

CMS highlights for 2021:
  • Over 94% of Medicare Advantage plans will offer additional telehealth benefits reaching 20.7 million beneficiaries, up from about 58% of plans offering telehealth benefits in 2020. In 2019, CMS implemented legislation signed by President Trump to give seniors enrolled in Medicare Advantage plans access to additional telehealth benefits from the convenience of their homes.
  • For the first time, 53 Medicare Advantage plans will offer increased access to palliative and integrated hospice care to their enrollees through the Medicare Advantage Value-Based Insurance Design Model.
  • Expect more opportunities for seniors to choose from Medicare Advantage plans that provide extra healthcare benefits to keep people healthy. About 730 plans will provide about three million Medicare Advantage enrollees with these additional types of supplemental benefits (such as adult day health services, caregiver support services, in-home support services, therapeutic massage or home-based palliative care) that are primarily health related under a new interpretation adopted in 2019. This marks a 46% increase from the 500 MA plans in 2020.
  • Expanding access to reduced cost sharing to benefits for enrollees with certain conditions, such as diabetes and congestive heart failure, due to the agency’s reinterpretation of the 2018 uniformity requirement. About 500 plans will offer up to 2.5 million Medicare Advantage enrollees with particular conditions access to lower copayments or additional benefits such as meals and transportation.
  • About 920 plans reaching 4.3 million beneficiaries will offer non-primarily health related benefits tailored to people with chronic conditions that may help them better manage their diseases. Examples of these benefits include pest control, home cleaning services, home meal deliveries and transportation for non-medical reasons.
  • More than 440 Medicare Advantage plans will participate in the 2021 Medicare Advantage Value-Based Insurance Design Model, with over 1.6 million beneficiaries projected to receive additional benefits such as healthy foods and meals, transportation support, reduced cost-sharing and rewards and incentives aligned with Part D drugs. This represents a 20-fold increase in Medicare Advantage enrollees benefiting from the model compared to 2019.

CMS will also release a request for applications, including for the hospice benefit component, for the Medicare Advantage Value-Based Insurance Design Model plan for 2022 later this fall.

For the first time, 53 MA plans will offer increased access to palliative and integrated hospice care to their enrollees through the Medicare Advantage Value-Based Insurance Design (VBID) Model. CMS is conducting this Model test through the CMS Innovation Center (CMMI) under Section 1115A of the Social Security Act.

The project will test inclusion of hospice in the VBID — often called the Medicare Advantage hospice carve-in — and will be a small program in its first year. The 53 participating Medicare Advantage plans cover 8% the market and a limited geographic footprint, according to CMS data.

Starting in 2021, payers and hospice providers will have the option to participate in the demonstration, which according to CMS is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and other clinicians.

Despite these changes, end-of-life care providers are concerned about diluting traditional hospice benefits and negotiating rates with MA plans.

In a statement, the National Hospice and Palliative Care Organization (NHPCO) says it supports innovation that enhances opportunity for access to high-quality, interdisciplinary care, but continues to have serious concerns about timing for implementation, the impact on beneficiary access to high-quality care and lack of beneficiary protections.

“The 2021 VBID Model represents a missed opportunity for CMMI to innovate the way hospice care is delivered. While the application mentions ‘palliative care’ and ‘transitional concurrent care,’ and encourages plans to innovate, it does not mandate particular coverage for that care. We have seen that innovation without baseline requirements can sometimes lead to barriers to care. Additionally, the model does not waive the six-month prognosis requirement for hospice eligibility. This is a missed opportunity to expand access to hospice. We are also disappointed in the dearth of necessary consumer protections,” said NHPCO President and CEO Edo Banach.

How home health and hospice providers can prepare for the changes coming to Medicare Advantage 

Waystar makes things easier and more efficient for your team with solutions tailored to the specific needs of those in the home health and hospice space. And, with our recent acquisition of industry pioneer eSolutions, we’ve only elevated our Medicare offerings with direct, real-time access to FISS, helpful compliance tools and much more. Waystar is now the only market-leader offering access to government, commercial and patient payments.

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