Home care and senior service advocates are urging the Centers for Medicare and Medicaid Services to crack down on Medicare Advantage plans if the plans don’t provide the same level of care that fee-for-service plans do.
In recent comments submitted to CMS, National Association for Home Care and Hospice President William Dombi asked the agency to hold MA plans accountable for noncompliance if they fail to cover the same services as traditional Medicare plans.
“Home health agencies consistently raise concerns about restrictions on services to
MA plan members when under a home health plan of care,” Dombi stated. “In [a] NAHC survey, 63% of respondents indicated the MA plans disallowed services that are routinely billable under the Medicare home health benefit.”
In August, CMS published a Request for Information, asking the public for input regarding various aspects of the MA program. Comments were due last week. The comments may inform potential future rulemaking or other policy development, CMS said.
The growing popularity of MA plans has been raising scrutiny from government watchdogs. A recent Office of Inspector General report found the plans often delay or deny services that are covered by Medicare. The Partnership for Quality Home Healthcare echoed concerns outlined in the OIG report in comments it submitted to CMS. PQHH CEO Joanne Cunningham stated MA plans often drag their feet in granting approval to hospitals hoping to release patients to home health.
“The MA enrollees we serve who seek skilled care in the home as the next appropriate care
settings following an acute hospital stay report a high rate of initial denials from MAOs that also contribute to delays in transfer and an avoidable misuse of acute care resources,” Cunningham wrote.
Senior Services nonprofit LeadingAge accused MA plans of short-changing home health providers by reimbursing them on a per-visit basis, rather than the higher Patient Driven Groupings Model (PDGM) rate. LeadingAge also took issue with the low payment rates MA plans provide to skilled nursing providers.
MA plan enrollment has been increasing as the nation’s 72 million aging baby boomers qualify for Medicare. A recent report from Kaiser Family Foundation found 48% of the eligible Medicare population is now enrolled in MA plans. The private plans account for 55% of total Medicare spending.