​By Elizabeth E. Hogue, Esq.
 
Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute. This statute generally prohibits anyone from either offering to give or actually giving anything to anyone in order to induce referrals. Case managers/discharge planners who violate the anti-kickback statute may be subject to criminal prosecution that could result in prison sentences, among other consequences.

CMS released a Request for Information seeking public comment on the Medicare Advantage program. HCAOA will be submitting comments on behalf of members, and all members are encouraged to send comments or feedback to eric@hcaoa.org by August 24.

​CMS has announced the first-ever home and community-based services (HCBS) quality measure set. This voluntary measure set is intended to promote consistent quality metrics within and across state Medicaid HCBS programs.

​Last week, the Better Medicare Alliance released we just released the 2022 State of Medicare Advantage report, which compiles the latest research and data to deliver a comprehensive picture of the Medicare Advantage experience today – from beneficiary demographics and enrollment trends to supplemental benefit offerings and consumer savings, to health outcomes and bipartisan support in Washington.

​This week, HCAOA joined 70 other consumer groups, provider associations, health systems, community-based nonprofits, and other health leaders urging CMS to ensure continued support for Medicare Advantage beneficiaries.

​In Performance Year 7 of the Independence at Home (IAH) Demonstration (2020), CMS found that the expenditures for IAH practices’ applicable beneficiaries were approximately 18%, or equating to $42.3 million below their spending targets, an average reduction of $6,585 per beneficiary. All 10 IAH participants (nine practices and one consortium) reduced the per-beneficiary-per-month (PBPM) expenditures relative to the practice’s PBPM spending target. A total of 6,436 beneficiaries were enrolled in the demonstration at 10 participating practices.

The nation’s leading research and advocacy organization supporting Medicare Advantage, Better Medicare Alliance (BMA), released a statement on the annual Medicare Trustees Report from the U.S. Department of the Treasury, Departments of Health and Human Services and Labor, CMS, and the Social Security Administration.
 
The report shows an improved fiscal outlook compared to last year and predicts that funds will last two years longer than expected. BMA President and CEO Mary Beth Donahue said in the statement she hopes the news will encourage policymakers to continue making advancements in MA to protect the nation’s seniors and individuals with disabilities.

The Long-Term Quality Alliance and ATI Advisory released a policy report last week highlighting three top recommendations for Congress to advance non-medical benefits in Medicare Advantage (MA).
 
The report notes that the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act made strides in advancing holistic care to improve the quality of life for Americans with complex medical needs. In addition, the Special Supplemental Benefits for the Chronically Ill (SSBCI) gave MA the flexibility to address the diverse needs of these individuals, but according to the report, they believe three policy recommendations would advance these supplemental benefits to improve upon the framework already in place.

A recent update from the CDC recommends that certain immunocompromised individuals and people over 50 years who received an initial booster dose at least four months ago are eligible for another booster to increase their protection against COVID-19. People with Medicare can get a second Pfizer-BioNTech or Moderna COVID-19 vaccine at no cost with no applicable copayment, coinsurance or deductible. CMS is covering the cost for qualified individuals in an effort to ensure maximum access to COVID-19 vaccinations. Medicaid beneficiaries can also get COVID-19 vaccines, including first boosters, at no cost.
 
​The CDC also recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least four months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.
 
More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html and through the CMS COVID-19 Provider Toolkit.
 
Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

The Biden-Harris Administration announced that Americans with Medicare Part B, including Medicare Advantage, can access up to eight free over the counter COVID-19 tests each month.
 
Members: this is an opportunity to assist your clients who are on Medicare to access at-home kits to reduce the spread of COVID-19.

Medicare is not requiring participating eligible pharmacies and health care providers go through any new Medicare enrollment processes.
 
National pharmacy chains participating in this initiative include Albertsons Companies, Inc., Costco Pharmacy, CVS, Food Lion, Giant Food, The Giant Company, Hannaford Pharmacies, H-E-B Pharmacy, Hy-Vee Pharmacy, Kroger Family of Pharmacies, Rite Aid Corp., Shop & Stop, Walgreens, and Walmart.
 
Additional eligible pharmacies and health care providers may also participate, so people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.
 
This initiative adds to existing options for people with Medicare to access COVID-19 testing, including:
 

• Requesting free over-the-counter tests for home delivery at gov. Every home in the U.S. is eligible to order two sets of four at-home COVID-19 tests.
• Access to no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here.
• Access to lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare.
• In addition to accessing a COVID-19 laboratory test ordered by a health care professional, people with Medicare can also access one lab-performed test without an order and cost-sharing during the public health emergency.

 
More information can be found on this fact sheet.
 
People with Medicare can get additional information by contacting 1-800-MEDICARE or visiting https://www.medicare.gov/medicare-coronavirus.
 
Medicare also maintains several resources to help ensure beneficiaries receive the correct benefits while also avoiding the potential for fraud or scams here.

​The Hospital Inpatient Modernization Act (S3792/HR7053) was introduced earlier this month to extend the CMS waiver that was initiated during the pandemic to provide acute care to patients in their homes.   

​Last week, HCAOA released “State of Home Care: Industry at a Crossroads” during a special livestream event featuring members and caregivers. This new report spotlights data and industry challenges, calls on home care industry leaders and policymakers to unite around six policy priorities that address the rapidly growing demand for care and to help Americans age in their own homes with comfort, safety and independence.