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.

HCAOA encourages all providers considering the Guiding an Improved Dementia Experience (GUIDE) Model to thoroughly assess its financial feasibility.

​It is crucial for home care providers to carefully evaluate the associated expenses tied to participating in the GUIDE Model. This includes the costs of providing in-home respite care and conducting in-person face-to-face live assessments, both mandated components of the GUIDE Model. Furthermore, assessing the financial implications helps home care providers determine whether the GUIDE Model allows for profitability under the payment rates set by the Center for Medicare & Medicaid Services (CMS). This evaluation is critical in determining if implementing the GUIDE Model allows your business to meet its financial goals and is sustainable for your home care agency.

According to a recent article in Home Health Care News, the payer source most likely to dictate the future of home-based care providers is Medicare Advantage (MA), even though plans’ in-home supplemental benefit offerings will take a dip for the first time in 2024. In-home support services (IHSS), which offer an MA entry point for home care providers, grew rapidly from 2020-2023, with the amount of plans offering them growing from 283 to 1,308. In 2024, though, only 867 plans will be offering IHSS, according to the research and advisory firm ATI Advisory.

In a recent policy report, the Better Medicare Alliance (BMA) recommended a set of solutions aimed at enhancing Medicare Advantage for beneficiaries and the broader Medicare program. A critical aspect of these proposed solutions is ensuring a stable payment environment to maintain affordable, high-quality care for beneficiaries and enable innovation in benefit design and care delivery. This stability is crucial, given the ongoing regulatory changes in Medicare Advantage. 

On October 10, it was announced all 10 drug companies selected for Medicare Drug Pricing Negotiations Program'sfirst cycle have opted to participate. These companies manufacture some of the most expensive and commonly used prescription drugs. These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, representing about 20% of the total Part D gross covered prescription drug costs between June 1, 2022, and May 31, 2023. Medicare enrollees taking these 10 drugs paid a total of $3.4 billion in out-of-pocket costs in 2022.

The Better Medicare Alliance released its 2023 State of Medicare Advantage Report, which shows record-setting enrollment in Medicare Advantage plans. The report highlights several key findings, including the fact that in-home support services provided by Medicare Advantage plans increased 50% between 2022 and 2023. The average monthly premium for Medicare Advantage beneficiaries in 2023 is at a 16-year low of $18. Beneficiaries report spending significantly less on out-of-pocket costs and premiums annually, resulting in $2,400 in savings, which amounts to 44% less than other Medicare options. Medicare Advantage offers substantial value to both beneficiaries and the federal government, covering all Medicare-covered services for 24% less than Fee-For-Service (FFS) Medicare. Additionally, 95% of beneficiaries are highly satisfied with their coverage. Between 2022 and 2023, in-home support services increased 50%.

AARP's Long-Term Services and Supports (LTSS) 2023 State Scorecard Report was just released and reveals significant gaps in the care provided to older adults and individuals with disabilities in the United States. Although there has been some overall progress compared to the 2020 update, every state still has areas that require improvement. 

Choices for Increased Mobility Act of 2023 H.R. 5371 is designed to enhance patient access to a wider range of wheelchairs. It allows for code upgrades for titanium and carbon fiber wheelchairs under Medicare. This legislation seeks to offer wheelchair users a choice of products that align with their medical and lifestyle needs and remove financial barriers that have prevented some Medicare beneficiaries from accessing titanium and carbon fiber mobility solutions. The bill has been introduced in the House and referred to the Committee on Energy and Commerce as well as the Committee on Ways and Means.