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New CMS Final Rule Adds Non-Skilled In-Home Care as Medicare Advantage Benefit in 2019

The Centers for Medicare & Medicaid Services (CMS) recently announced a final rule allowing Non-skilled in-home care services as a supplemental benefit for Medicare Advantage (MA) plans in 2019. This is first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage.

The announcement is a part of CMS’ expanded definition of “primarily health related,” which allows supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

MA payors, including Humana, UnitedHealthcare, and Aetna, have begun focusing more on the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, and are ready and willing to pay for non-skilled in-home care services.

According to CMS data, 35% of Medicare beneficiaries were participants in MA in 2015. This number is expected to increase considerably over the next several years.

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