Yesterday, Vice President Kamala Harris announced a new proposal to expand Medicare coverage to help cover the cost of home care for seniors. HCAOA is currently analyzing the proposal, but notes that any initiative to shift the focus from institutional care to home-based care is a meaningful step toward closing gaps in the healthcare system.

Better Medicare Alliance recently released its 2024 State of Medicare Advantage report. This report provides a comprehensive overview of Medicare Advantage (MA), covering everything from beneficiary demographics and enrollment trends to supplemental benefits, consumer savings, and improvements in health outcomes.

HCAOA Associate Member The Helper Bees has introduced a flexible benefit card called helpful™, which grants access to over-the-counter (OTC) products, groceries, and a nationwide network of vetted Social Determinants of Health (SDoH) providers through a unified card experience. The helpful™ card works like a prepaid debit card. Payers can load money onto the card for eligible products and services.

​CMS has published a new fact sheet about the services available through the Guiding an Improved Dementia Experience (GUIDE) Model, along with guidance on how patients and families can work with their healthcare providers to access GUIDE services and supports. GUIDE focuses on dementia care management and aims to improve the quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities.

CMS has announced a proposed decrease in payments to Medicare-certified home health agencies for FY 2025. The aggregate reduction amounts to 1.7%, totaling approximately $280 million. This includes a permanent prospective adjustment of -4.067% to the home health payment rate under the Patient-Driven Groupings Model (PDGM). Despite a proposed 2.5% payment increase for FY 2025, this is offset by a 3.6% estimated decrease in proposed permanent behavior adjustments and a 0.6% decrease due to a proposed fixed-dollar loss ratio (FDL), according to CMS.

All providers are invited to participate in CMS’ Open Door Forum on Tuesday, July 30 at 2:00 p.m. for an  overview of the home and community-based services (HCBS) provisions in the Ensuring Access to Medicaid Services Final Rule, including a deeper dive on what is commonly referred to as the “HCBS payment adequacy provision.”

Last week, the Georgia Department of Community Health (DCH) informed the HCAOA Georgia Chapter that it received approval from CMS for the Independent Care Waiver Program (ICWP) and Elderly and Disabled Waiver Program (EDWP) amendments submitted in May. The waiver amendments for both ICWP and EDWP were approved with an effective date of July 1, 2024.

Change Healthcare said it has begun notifying people who were impacted by the cyberattack on patient data in February. (press release)

A new tool was recently published by Better Medicare Alliance, which provides enrollment numbers by state through an interactive map or via the drop-down menu. Enrollment data is provided by CMS. Members may find this map useful as it identifies the number of Medicare Advantage beneficiaries who live in your service area.

The Centers for Medicare and Medicaid Services (CMS) have finalized the Medicaid Access Rule. ​HCAOA supports certain aspects of this rule; however, the 80/20 provision will cause many Medicaid providers to either curtail services or cease providing services entirely, resulting in reduced patient access.

The Centers for Medicare & Medicaid Services (CMS) announced the release of the final rule, Streamlining Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes (CMS-2421-F2), making it easier to enroll in and retain Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) coverage. This rule is a response to President Biden’s Executive Orders (January 2021 and April 2022) to strengthen Medicaid and access to quality health coverage by simplifying enrollment and ensuring continuity of coverage, particularly for vulnerable populations like children, the elderly, and individuals with disabilities.

Don’t forget to register for Polsinelli's Home Care Industry Update tomorrow, March 14, at 12:00 p.m. ET. HCAOA CEO Jason Lee will participate in a panel discussion with representatives from Polsinelli and The National Association for Home Care & Hospice (NAHC) for a comprehensive overview of the latest legislative and legal developments.

HCAOA members are invited to register for Polsinelli's Home Care Industry Update on March 14 at 12:00 p.m. ET. HCAOA CEO Jason Lee will participate in a panel discussion with representatives from Polsinelli and The National Association for Home Care & Hospice (NAHC) for a comprehensive overview of the latest legislative and legal developments.

Home care providers have the potential to impact a greater number of patients, enhance health outcomes, and promote health equity by capitalizing on opportunities within Medicare Advantage (MA) plans. The growing prevalence of MA plans offers home care providers various tools to attract more patients, with the Value-Based Insurance Design (VBID) model identified as an opportunity in a HealthAffairs report. This model provides MA organizations with strategies to expand their client base and reduce costs by utilizing broader "targeting criteria," such as frailty. The report emphasizes that relying solely on claims-based diagnosis criteria may overlook a significant portion of vulnerable individuals lacking the necessary medical claims to support their need for home care.