Medicare Advantage (MA) beneficiaries who are Black, Hispanic, or Asian American/Pacific Islander (AA/PI) receive higher rates of preventive health screenings and primary care services and lower rates of avoidable inpatient services compared to similar beneficiaries in traditional fee-for-service Medicare, according to an analysis released last week by Berkeley Research Group (BRG). Using Medicare claims and MA encounter data, BRG professionals also found that enrollees in special needs plans often had the greatest advantage over similar enrollees in traditional Medicare.

In a 53-45 vote along party lines last week, the Senate confirmed the nomination of Dr. Mehmet Oz as administrator for the Centers for Medicare and Medicaid Services (CMS).

​HCAOA member Right at Home has partnered with PocketRN to support dementia patients through the Centers for Medicare & Medicaid Services (CMS) Guiding an Improved Dementia Experience (GUIDE) model. This collaboration offers Right at Home clients access to PocketRN's "virtual nurse for life" system, which provides continuous nurse-led education, coaching, monitoring, and support. It also allows Right at Home to offer respite care services, a feature of the GUIDE model.

The Center for Medicare & Medicaid Services (CMS) recently updated the Medicaid eligibility standards for 2025, which reflects a 2.9% price increase between 2023 and 2024.

The Centers for Medicare & Medicaid Services (CMS) has finalized a home health prospective payment rule for 2025 that includes a 0.5% aggregate increase in Medicare home health reimbursement, translating to approximately $85 million. This adjustment marks a shift from the proposed 1.7% decrease, reflecting ongoing adjustments related to the Patient-Driven Groupings Model (PDGM). Despite this improvement, stakeholders in the home health sector expressed dissatisfaction, emphasizing that the overall trend has been toward significant cuts and insufficient recognition of inflationary pressures on costs.

HCAOA joined NAHC, LeadingAge, ANCOR, and other industry leaders for a quarterly meeting with the Centers for Medicare and Medicare Services (CMS) last week as CMS continues to seek feedback regarding the implementation of the Medicaid Access Rule. Throughout the meeting, our coalition of industry leaders continued to stress the potential impact of the 80/20 provision on providers and provided recommendations for sub-regulatory guidance that has yet to be articulated by CMS, such as reporting and audit requirements, to ensure state-by-state continuity in implementation and to mitigate unnecessary administrative burden on providers.

A recent report from the University of California San Francisco (UCSF) highlights significant barriers preventing seniors with cognitive impairment from accessing home care services. Approximately 4.3 million seniors in the U.S. live alone with cognitive challenges. Yet, nearly 80% cannot obtain home care aides through programs like Medicaid due to their ineligibility to qualify for Medicaid. Many of these seniors struggle with daily activities and receive little to no assistance from family or friends.

Last week, both presidential candidates announced their plans for home care expansion. Vice President Kamala Harris proposes broadening Medicare benefits to cover home health care, with the expansion of Medicare drug price negotiations covering the cost. Former President Donald Trump would prioritize home care benefits by increasing access to telehealth for seniors in Medicare Advantage plans, shifting resources back to at-home senior care, overturning disincentives that lead to Care Worker shortages, and supporting unpaid Family Caregivers through Tax Credits and reduced red tape. As mentioned in our statements last week, HCAOA is committed to making home care more accessible and affordable and looks forward to collaborating with policymakers, Congress, and either Former President Donald Trump or Vice President Kamala Harris.

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.