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Medicare Advantage Update

By Stephen Tweed  

As a regular reader of the Home Care CEO Report, you know that we have been following the introduction of in-home care through Medicare Advantage plans since the rule was introduced on April 27, 2018.  In case you missed it, here’s a link to our previous article from 8-22-18

To keep you up to date on new developments in this important industry trend, here are some additional facts and data.

  • In-Home Support Services is one of nine new support services that CMS has authorized Medicare Advantage Plans to offer beginning in 2019.
  • The Rule Change came from The Chronic Care Act, part of the Bipartisan Budget Act of 2018.
  • Medicare Advantage covers more than 1/3 of 56 million people enrolled in Medicare.
  • CMS pays MA plans a per member per month fee.  In 2004 the government implemented a risk-adjustment model to adjust payment based on demographic information and health conditions of each member.
  • Annual payment to MA plan for 84-year-old male with diabetes would be $6,765.  Add on a diagnostic code for vascular disease and the rate for the same patient would be $9,796. source: MedPac
  • Average Risk Scores for Medicare Advantage enrollees is about 8% higher than Medicare Fee-for-service beneficiaries.  Medicare Advantage plans were paid 2 to 3% more in 2016 than they would have been for patients treated under Fee-for-service. source: MedPAC
  • Right At Home, a top-tier home care franchisor, has announced a “preferred partnership arrangement” with Kindred At Home, the largest provider of home health and hospice services.  Kindred At Home is owned by Humana, the second largest Medicare Advantage managed care organization.
  • Senior Helpers, the 10th largest home care franchisor,  has added a new member to its leadership team to forge Medicare Advantage partnerships and showcase the value of in-home caregivers to clinicians. Michael Hughes is the new vice president of strategic development at the company. Senior Helpers has 303 franchise locations.

If you have access to other facts or information about Medicare Advantage plans and the addition of In-home Support Services, please let us know.  Stay tuned for additional information as it becomes available.

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