In The News

A New Biden Proposal Would Make Changes to Advantage Plans for Medicare: What to Know

USA TODAY | By Maureen Groppe

WASHINGTON − The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.

“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra.

If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs.

Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans.

Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

Here’s what you need to know.

Extra Medicare Benefits

Nearly all Medicare Advantage plans offer extra benefits such as eye exams, dental and fitness benefits. They’re offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services.

But enrollees use of those benefits is low, according to the Centers for Medicare and Medicaid Services.

To prevent the extra benefits serving primarily as a marketing ploy, the government wants to require insurers to remind seniors mid-year what’s available that they haven’t used, along with information on how to access the benefits.

“The rule will make the whole process of selecting a plan and receiving additional benefits more transparent,” Becerra said.

Broker Compensation Limits

Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. Officials said the change would also help reduce market consolidation.

“Some large Medicare Advantage insurance companies are wooing agents and brokers with lavish perks like cash bonuses and golf trips to incentivize them to steer seniors to those large plans,” said Lael Brainard, director of Biden’s National Economic Council…

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2023 RIHC Home Care Chartbook, Co-Sponsored by NAHC

The Institute is excited to announce the 2023 RIHC Home Care Chartbook is now available online! 

Highlighted by data on Medicare Advantage home health patients, workforce trends, and more, the Chartbook is an invaluable tool for understanding the role home care plays in the U.S. healthcare landscape. 

Released annually, the Chartbook, co-sponsored by the National Association for Home Care & Hospice (NAHC), and compiled and charted by KNG Health Consulting LLC, summarizes and analyzes statistics on home health from a range of government sources. The Chartbook offers a glimpse of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies. The Chartbook includes updated statistics from the Bureau of Labor Statistics, the U.S. Department of Commerce, Medicare Cost Reports, Home Health Compare, Medicare fee-for-service claims, the Medicare Current Beneficiary Survey, and other data from CMS. 

We would like to thank 2023 Chartbook sponsor NAHC for their continued support of the Institute and the Chartbook. Learn more about NAHC at

A copy of the 2023 RIHC Home Care Chartbook is available here

Please join us for a webinar with the team from KNG, along with our co-sponsors at NAHC, on Wednesday, December 6th at 2 pm ET. Register now here.

For more information on the Chartbook, please reach out to the Institute's Executive Director, Jen Schiller, at [email protected] or (771) 203-0595.


How CMS’ Goal To Enroll All Medicare Beneficiaries In ACOs Could Impact Home-Based Care Providers

Home Health Care News | By Joyce Famakinwa
The U.S. Centers for Medicare & Medicaid Services (CMS) has stated its objective to enroll all of its Medicare beneficiaries in accountable care relationships by 2030.
Currently, roughly 13.2 million Medicare fee-for-service beneficiaries are assigned to an ACO. 
With this in mind, there has been more activity and investment around accountable care organizations (ACOs), including for at-home care providers, which are strategically collaborating with these organizations.
The Walgreens Boots Alliance-backed VillageMD — a Chicago-based primary care services organization that has an at-home care arm — is one provider that is working heavily in the ACO space. The company is a participant in the ACO REACH Model, for example. 
Andrea Osborne, senior vice president of ACO operations and delegated services at VillageMD, pointed out that the ACO REACH model allows providers more leg room to approach CMS about various concerns and suggestions.
“We actually get to go to CMS and have conversations, and say, ‘Hey, the Medicare rule isn’t working for us,’” she said Tuesday during a panel discussion at the annual LeadingAge conference in Chicago. “‘We’d like to try it that way.’ We have these conversations.”
Amid the pandemic, the company approached CMS about expanding at-home care services, for instance.
“We said, ‘We want to be able to use home health care anywhere,’ and then they actually ended up opening that up for everyone,” Osborne said. “That’s because we had tested these models, so it’s really important that when you are in these partnerships – if there are barriers to care that are Medicare regulations – you’re speaking with your ACO partner, because we actually can get opportunities to test changing those rules.”
Medicare Shared Savings Program (MSSP) ACOs are an opportunity for home-based care providers to enter the space.
The majority of MSSP ACOs are hospital-based. As a result, these ACOs are focused on a patients’ post-acute stay after a hospitalization, according to Andy Edeburn, a consultant at Elder Dynamics, an advisory services company for aging services providers.
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‘Do The Homework’: What Home Health Providers Need To Know Before Sitting Down With Payers

Home Health Care News | By Patrick Filibin
Diving into value-based arrangements with payers always sounds good, in theory, for home health providers.
But it is easier said than done. Providers have to commit to value-based care, but even before that, they need to do their homework to be successful over the long haul.
Moving away from fee-for-service and moving toward risk through value-based arrangements takes a tremendous amount of research, operational awareness and financial investment.
It also requires legwork before, during and after negotiations with payers.
“In my experience, what happens so often is that providers get brought into these conversations without doing their homework first,” Fred Bentley, managing director at ATI Advisory, told Home Health Care News. “All of a sudden, they’re at the table and they think, ‘Let’s wing it.’ Or they will let the payer dictate the conversation, and the provider is just in reaction mode.”
What providers can do
Before sitting down at the table with payers, providers should clearly understand their goals. It may seem like a no-brainer, Bentley said, but it’s often an overlooked aspect of the process.
“It sounds so obvious, but ask yourself, ‘As a home health provider, what are we trying to achieve here?’” Bentley said. “There are different objectives. It can split into two paths: are you looking to grow your core business and are you using value-based care as a tool to be a more preferred critical partner in the eyes of the payer? And, it’s not mutually exclusive, but on the flip side, do you see real revenue upside?”
It’s quantitative versus qualitative, Nick Seabrook, managing principal at SimiTree, told HHCN.
“What do you want to get out of this?” Seabrook said. “You can get into it from a dollar and cents standpoint — prioritizing revenue. Or you can get into it with almost a marketing approach and say, ‘We have this relationship with a certain payer because we’re succeeding in this,’ and that could open the door to other referral sources.”
Also in order: a brutally honest look at what a provider’s value proposition is.
One of the challenges home health faces in particular, Bentley said, is that they are late to the game.
“They’re not out of the picture, but it’s not uncommon for payers to say, ‘We empower the primary care doctors and shift the risk to them — what can home health bring to the table?’” Bentley said. “That’s when you find your value prop — providers should have a painfully honest discussion about what they could bring to a Humana, for instance. What is it that you bring to the table, and how do you convince them that you’re ready for this?”…

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CMS Seems Intent On Sticking With Home Health Care’s Review Choice Demonstration

Home Health Care News | By Andrew Donlan
The Review Choice Demonstration (RCD) has received a set of diverse reactions since it has been live. Some home health providers find it useful and others find it to be yet another administrative burden. 
Either way, the U.S. Centers for Medicare & Medicaid Services (CMS) seems intent on expanding it. 
Broadly, the goal of RCD is to reduce improper billing in home health care. Illinois, Ohio, Texas, Florida and North Carolina providers have all participated at this point. An expanded implementation drew major criticism in some states, particularly during COVID-19. 
Now, the worst of COVID-19 has passed, and CMS is continuing its expansion of the demonstration, this time in Oklahoma. That will start in less than a month, on Dec. 1, 2023. 
“The choice selection period for Oklahoma will begin on Oct. 16, 2023, and will remain open until November 15, 2023,” Emily Richmond, who works on RCD for the Center for Program Integrity, said on a recent home health stakeholder call hosted by CMS. “Home health providers in Oklahoma can select from pre-claim review, post payment review, or a minimal post payment review with a 25% payment reduction, which means 100% of those claims have a 25% payment reduction.”
Meanwhile, the demonstration is set to expire in other states on May 31, 2024. CMS is currently considering extending it, though. 
“At this time, we have the demonstration set to end in May of 2024, but CMS is currently working internally to determine if the demonstration will be extended past that May expiration date, and we will definitely provide ample notice,” Jessica Czulewicz, who also works on RCD, said during the call. “At this point, that’s about the best answer I can give.”
Multiple sources have told Home Health Care News that they believe CMS is bullish on RCD and plans to continue expanding it. 
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