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.
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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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‘Boots On The Ground’: Why Home Care Provider-Home Health Agency Partnerships Work

Home Health Care News / By Joyce Famakinwa
 
Personal home care and home health care are both branches connected to the post-acute care family tree. As such, home care leaders believe that there are numerous ways that their organizations can help alleviate home health provider pain points.
 
One major pain point that can be seen across home health care are referral rejection rates. Last year, the industry had a 76% referral rejection rate, compared to 54% in 2019, according to data from WellSky. 
 
Jeff Bevis, chief operating officer at Caring Senior Service, sees home care as a natural ally for home health providers that are struggling in this area. 
 
“It’s been a matter of time [that we] partner with them,” he told Home Health Care News. “[One way we do] is by trying to limit the hours, or the time, that the home health nurse is spending with their client. In other words, when the home health nurse is with a client for 15, 30 or even 60 minutes, home care workers can pick up more of the non-medical client needs to keep them happy and healthy in the home.” 
 
The San Antonio, Texas-based home care franchise company Caring Senior Service has roughly 50 locations across nearly 20 states.
 
Bevis noted that this kind of arrangement gets to the heart of the referral rejection rate problem. It allows the home health agency to take on more referrals without making new hires or having to stretch their existing employees.
 
Currently, Caring Senior Service is collaborating with two home health agencies in rural Illinois to help lift the burden on these providers.
 
“We assigned a care manager to each of those home health agencies, and they’re meeting with those agencies once a week to talk through the patients that are most in need of non-medical home care activities and services, in order to reduce the amount of time and pressure on the home health agency,” Bevis said. “It lets us pick up a larger part of that slack for them, and makes more efficient use of their home health nurses.” 
 
On its end, partnering with home health providers has been a referral boon for Caring Senior Service…

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