2019 Outlook on CMS Medicare Advantage Coverage of Home Care Services
As previously reported, the Centers for Medicare and Medicaid Services (CMS) issued guidance early in 2018 expanding what it would consider an allowable supplemental benefit beginning in 2019. Under CMS’ new expanded definition, plans may offer new types of supplemental benefits to enrollees, including in-home support and services. CMS also expanded certain types of benefits that were previously allowed. For example, CMS will now allow MA plans to offer temporary home modifications, such as stair rails and treads, in addition to bathroom safety devices that were previously allowed, such as grab bars in the shower. CMS expects that plans will experiment with new benefit offerings and make determinations about what is effective in keeping patients safely in the home and out of the hospital and emergency room.
A new report by the actuarial consulting firm Milliman highlights the uptake of new supplemental benefits by MA plans. In total, Milliman identified 102 plans that are set to offer one or more of the new supplemental benefits in 2019, representing roughly 3 percent of MA plans nationally. The report does not break down the number of plans that may be offering an expanded version of a previously allowed benefit, so the actual uptake of the new flexibilities is likely higher than it appears. A breakdown of how many plans will offer the new benefits is represented in Figure 2.
Figure 2. Summary of Expanded Supplemental Benefits in 2019
Benefit
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Plans Offering Benefit
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Adult Day Care Services
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0
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Home-Based Palliative Care
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29
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In-Home Support Services
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51
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Medically-Approved Non-Opioid Pain Management
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22
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Standalone Memory Fitness Benefit
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0
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Total (no plan offered more than 1 new benefit)
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102
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MA plans had to consider multiple factors when designing bid and benefit packages for 2019, including whether or not to offer new benefits and to what extent. As we previously reported, the Long-Term Quality Alliance (LTQA), a community of organizations focused on improving the lives of those with functional limitations, recently interviewed several MA organizations to analyze their response to the new opportunities in supplemental benefits. Most MA organizations welcomed the new flexibilities and expressed interest in exploring offering new benefits. However, they were challenged by several factors, including:
- The lack of clarity in CMS guidance as to what would be allowed and what restrictions would be in place;
- The compressed timeline between the issuance of the guidance and the deadline to submit 2019 bid and benefit packages; and
- Uncertainty around how to properly communicate new benefits to enrollees.
As a result, many MA plans are viewing 2019 as an experimental year in which to test new benefits on a limited scale to determine what achieves the goals of improving care while creating efficiencies in the health care system. If they determine that new benefits are working to improve the health of their enrollees, they will consider scaling the benefits up in future years. Please see the LTQA report again here.
More Changes Coming in 2020
While 2019 is largely seen as a test year for new benefits, 2020 is likely to see even more innovation and uptake of new benefits. Earlier this year Congress passed, and President Trump signed into law, the Bipartisan Budget Act of 2018, which included several provisions impacting the MA program. Specifically, the law further expands supplemental benefits beginning in 2020 by eliminating the requirement that benefits be “primarily health-related.” By expanding the definition of supplemental benefits beyond this standard, Congress has opened the door to offer benefits that directly address social determinants of health, such as nutrition and social isolation. The law requires that these new benefits be targeted to individuals with chronic conditions. Upcoming guidance from CMS early this year is expected to provide more clarity in defining what this will mean in terms of the types of benefits MA plans may offer and to which beneficiaries.
Courtesy: Better Medicare Alliance
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Upcoming Dementia Webinar Series Scheduled Later this Month
Please join us for a two part webinar series featuring Dr. Deborah Bier as she shares valuable tools and methods for home care providers to learn how to manage dementia behaviors and improving overall care for clients with dementia.
Speaker:
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Dr. Bier's work has successfully trained thousands of family and professional caregivers in dementia care best practices. She is an internationally respected educator and a beloved speaker. Dr. Bier holds a PhD in therapeutic counseling, a certificate in gerontology, and is a Certified Alzheimer’s Educator, Dementia Practitioner, and Dementia Care Partner.
Webinar #1: Dementia Behavior Management in Home Care
Date/Time: January 17, 2019 1:00pm EST
Description: In this webinar, Dr. Deborah Bier will discuss how to create dementia behavior handling success within home care. In addition, this presentation will include ten “secrets” few in home care understand about dementia and behavior handling.
Register For This Webinar
Webinar #2: The 4 Keys for Managing Dementia Behaviors
Date/Time: January 24, 2019 1:00pm EST
Description: In this webinar, attendees will be introduced to the four keys for managing dementia behaviors. In addition, attendees will learn how to improve care in the home, how to retain caregivers and clients, and how to compete successfully with other agencies and facilities in your community. Dr. Bier will troubleshoot some sticky dementia cases as examples of the quick improvements that are possible. Attendees will come away with concrete methods to immediately improve your “dementia game."
Register For This Webinar
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HCAOA Connecticut
Senate Committee Chairmen Appointed
Senate President Pro Tempore Martin M. Looney (D-New Haven) announced the Senate Democrats’ legislative committee chairmen and vice-chairmanships for the 2019-2020 legislative session. “The talent and experience embodied in both our returning and new members will help Connecticut to creatively pursue opportunities and confront challenges in the next two years to the benefit of the people of our state,” Sen. Looney said. Key committee chair appointments concerning home care include: Finance, John Fonfara (Hartford); Labor, Julie Kushner (Danbury); General Law, Doug McCrory (Hartford); Aging, James Maroney (Milford); and Human Services, Marilyn Moore (Bridgeport). In the coming days, House Democratic leadership will appoint committee chairmen and House and Senate Republican minority leaders will appoint ranking members. The legislative session begins next Wednesday, Jan. 9, 2019.
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HCAOA South Carolina
Save the Date
The HCAOA South Carolina Chapter will be meeting monthly in 2019. Our first meeting of the year will be held on January 23 at The Crossings at Five Forks Assisted Living in Greenville at 9:00 a.m.
Please keep an eye on your inbox for more information and a registration link.
This event will be free for chapter members.
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Minimum Wage Increases Across the Nation
Fox Business reports that 20 states will see minimum wage increases as 2019 begins. Additionally, 23 localities will be raising rates, according to a list compiled by the conservative-leaning Employment Policies Institute. Collectively, those policy decisions will result in an extra $5.4 billion worth of pay next year - a $90 to $1,300 average pay bump per year-round employee, depending on state of residence.
Here's a look at what will change starting in 2019:
California
While the statewide minimum wage in California will rise to $12, from $11, a slew of municipalities in the state are also raising their local minimum wages. In Mountain View, California - home to Google's headquarters - as well as Sunnyvale, the rates will increase to $15.65. In Los Altos, Cupertino, Richmond, El Cerrito, San Jose, San Mateo and Santa Clara, the minimum wage will be hiked to $15 per hour. The cities of Oakland, Redwood City and Belmont will also be raising wages.
New York
In the state of New York, the minimum wage will rise to $11.10, from $10.40. For quick service employees, the statewide rate will be higher, at $12.75. In New York City, the starting rate for employees will be increased to $15 per hour, from the current $13. Long Island and Westchester will also hike wages to $12.
Washington
Lawmakers in Washington State are hiking worker pay to $12, a $0.50 increase. However, some cities are raising their minimum wages much higher. In Seattle, minimum hourly pay will rise to $16. In SeaTac, it will increase to $16.09. Tacoma will see a more muted rise to $12.35.
Other states:
Alaska: $9.89, from $9.84
Arizona: $11.00, from $10.50
Arkansas: $9.25, from $8.50
Colorado: $11.10, from $10.20
Delaware: $8.75, from $8.25
Florida: $8.46, from $8.25
Maine: $11.00, from $10
Massachusetts: $12.00, from $11
Michigan: $9.45, from $9.25
Minnesota: $9.86, from $9.65
Montana: $8.50, from $8.30
New Jersey: $8.85, from $8.60
Ohio: $8.55, from $8.30
Rhode Island: $10.50, from $10.10
South Dakota: $9.10, from $8.85
Vermont: $10.78, from $10.50
Albuquerque, New Mexico, will raise its minimum wage to $9.20, while Las Cruces will increase it to $10.10. Flagstaff, Arizona, will see a $1 bump to $12 per hour.
View the full list of New Year’s wage hikes here.
Courtesy: Employment Policies Institute
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Texas Judge Finds Affordable Care Act Unconstitutional
A federal judge’s recent ruling that the Affordable Care Act is unconstitutional has put in question the future of the law. But it will need to survive review by higher courts to have any effect on the program that’s credited with expanding health insurance to about 19 million people in the U.S.
The White House confirmed Friday that the law remains in effect pending appeal, even as President Trump suggested Congress start working on a replacement. The ruling has “no impact to current coverage or coverage in a 2019 plan,” Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, stated after the ruling.
The opinion of federal Judge Reed O’Connor would be a shock to the health-care system, if it ever takes force. The ruling is written so that it won’t take effect immediately, giving higher courts time to consider the case.
The Fort Worth, Texas-based judge agreed with a coalition of Republican-led states that challenged the law in federal court, after Congress repealed the tax penalty for people who don’t buy insurance. The legitimacy of that fee was part of the Supreme Court’s justification for upholding the law in a previous challenge.
It will be up to higher courts to decide whether any elements of the law should be struck down -- and, if so, how to unwind policies that are now deeply enmeshed in America’s $3.5 trillion health-care system.
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Court Ruling Impacts Future of Joint Employer Issue
A new federal appeals court ruling complicates the National Labor Relations Board’s effort to limit “joint employment” liability for businesses.
The NLRB acted properly in 2015 when it adopted a more expansive test for determining when companies in franchise, staffing, and other relationships should be considered joint employers for liability and collective bargaining purposes, the U.S. Court of Appeals for the D.C. Circuit held Dec. 28. The board broke new ground with that test by saying that a company that has the authority to exert control over another company’s workforce could be required to bargain with or be held liable for unfair labor practices against the workers, even if it doesn’t exercise that ability.
The NLRB’s test, crafted by a Democratic majority, has been the subject of heated debate in the business community, courts, and Congress, highlighted by litigation involving McDonald’s and allegations against Microsoft. The now Republican-majority board is working on a regulation that would limit joint employment and allow businesses more leeway to outsource labor and other components.
The D.C. Circuit’s 2-1 ruling could constrain the agency to a standard close to the more expansive test for joint employment liability that’s currently in place. That’s because the court said the judicial branch has primary authority to define what is an ‘employer,’ as opposed to agencies.
The majority judges said courts are tasked with articulating the legal definition of “employer.” The NLRB can issue regulations and decide cases about when two companies are joint employers, but the agency has to conform to the judiciary’s definitions.
That creates some questions about how far the board can depart from the current joint employment test in a new regulation. It’s not clear whether the board will address those questions after reviewing public comments on the proposed regulation and in issuing a final rule.
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Congress Returns to Work This Week
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Tomorrow, the new Congress begins with a parliamentary ceremony where lawmakers swear their oath of office and ratify rules changes. Following her expected election as speaker, Nancy Pelosi will preside over the opening of a new Congress and administer the oath of office — en masse — to all new and returning House members.
In the Senate, Vice President Mike Pence will swear in newly elected senators.
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Home Care Association of America
444 N. Capitol Street NW, Suite 397, Washington, DC 20001
Phone: 800-22-HCAOA Email: info@hcaoa.org Website: www.hcaoa.org
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