Senator Casey Unveils Legislation to Increase Medicaid Home Care Funding

NAHC

Senator Robert Casey (D-PA), a staunch friend of the elderly and disabled, has unveiled legislation that would provide a 10 percent increase to the federal share (FMAP) of home and community-based services (HCBS) for two years. The legislation would essentially extend the HCBS funding from the American Rescue Plan Act (ARPA) and provide states with an additional two years of funding. The draft legislation provides a list of allowable uses for the funding, including:

Increasing payments to HCBS and home health providers;

• Providing sick leave and benefits to workers;
• Reducing waiting lists for HCBS waivers;
• Worker recruitment activities; and
• Other activities approved by CMS.

According to the Pennsylvania Rehabilitation & Community Providers Association, Senator Casey intends to formally introduce the bill later in October.

NAHC has contacted the Senator’s office to request that the legislation specifically include Private Duty Nursing as a service included in the 10 percent increase.

Senate Special Committee on Aging Seeks Answers on Oversight of Medicaid Managed Care Organizations

Home Care Association of America

Senate Special Committee on Aging Chairman Bob Casey (D-PA) sent a letter to CMS seeking information and raising concerns about the oversight of Medicaid managed care organizations (MCOs). Citing a recent report from the Office of Inspector General, Sen. Casey expressed concern over health insurance companies denying medically necessary care for individuals enrolled in Medicaid MCOs.

​These MCOs receive fixed annual fees, known as capitated payments, from state Medicaid programs to provide health insurance to Medicaid enrollees. However, the letter highlighted the OIG's warning that such payment models can create incentives for insurance companies to deny services to increase profits. Sen. Casey's letter requests information on the steps being taken by CMS and states to protect Medicaid enrollees and ensure that MCOs prioritize patient care over profit margins.

CMS Proposes Changes to the HCBS 1915(c) Waiver Application

NAHC

In September 2023, the Centers for Medicare & Medicaid Services (CMS) posted proposed updates to the 1915(c) Home and Community Based Services (HCBS) Waiver Application and Technical Guide in the Federal Register for public comment. According to CMS, the changes include technical edits and updates throughout both documents, such as adding an option for states to indicate whether HCBS can be delivered via telehealth and integrating settings criteria with person centered service planning requirements.

Crosswalks of the major changes, as well as redlined and final versions of both documents are available here: 2023 1915(c) Waiver Application PRA Renewal Materials.

1915(c) waivers are flexible and extensive service packages and are the most predominant way that state Medicaid agencies provide HCBS across the country. Changes to the HCBS Waiver Application and Technical Guide can have significant impact on the way that states administer their benefits. The public comment period closes on November 13, 2023. The Federal Register posting, including instructions for providing public comment, is available here: Federal Register Notice for 1915(c) Waiver Application PRA Renewal.

What Are Major Payers Offering Medicare Advantage Members in 2024?

Health Payer Intelligence / By Victoria Bailey

- As Medicare’s open enrollment period approaches, payers have announced new Medicare Advantage plan offerings for 2024.  
 
Because Medicare Advantage plans receive flexibility to cover benefits beyond the traditional Medicare offerings, plans have an opportunity to differentiate themselves from their competitors with new benefits. In their 2024 offerings, major payers prioritized $0 monthly premiums, low-cost prescription drug coverage, and benefits addressing social determinants of health. 
 
UnitedHealthcare, Humana, Cigna, and Aetna represent 18.3 million members and 60 percent of the Medicare Advantage market, according to estimates from KFF. Their new benefits provide insight into what payers are prioritizing in senior healthcare and their growing footprints can affect the Medicare Advantage payer landscape and consumers’ plan options. 
 
UnitedHealthcare
 
UnitedHealthcare is expanding its coverage area to reach 96 percent of all Medicare beneficiaries.

The payer currently offers an online hub members can use to access their benefits and manage their appointments. The UCard is integrated with UnitedHealthcare’s member website and mobile app. Members can use the UCard to check in at an in-network provider’s office or pharmacy and can spend rewards in-store or online.

In 2024, the payer will introduce new benefits that make it easier for members to shop with their UCard. A mobile product scanner will allow members to confirm benefit eligibility for covered products when shopping in-store. A mobile UCard will allow merchants to scan a barcode for payment when a member is ready to check out.
 
The payer has also expanded its reach to an additional 700,000 people eligible for Medicare Advantage plans in 110 new counties and 2.7 million additional people eligible for UnitedHealthcare’s chronic special needs plans.
 ..
Like many Medicare Advantage plans, UnitedHealthcare will continue offering dental, hearing, and vision coverage. In addition to having the largest Medicare Advantage network for medical providers, the payer boasts the largest national dental network, one of the largest national vision and hearing provider and retail networks, and one of the largest pharmacy networks.
 
In 2024, members will have stable or lower maximum out-of-pocket costs compared to 2023, according to the payer. In addition, standard Medicare Advantage plans will offer $0 copays for virtual visits, mammograms and colonoscopies, and routine dental, vision, and hearing exams…

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