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News for Iowa Health Care Association members and their employees May 8, 2018
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CMS guidance on new Medicare Advantage plan benefits
The Centers for Medicare & Medicaid Services (CMS) has issued two memos to the Medicare Advantage (MA) Plans with instructions on changes for contract year 2019. One memo, Reinterpretation of “Primarily Health Related” for Supplemental Benefits, relates to the expanded interpretation for health related benefits that plans will be permitted to offer their enrollees, such as home based support services. The second memo, Reinterpretation of the Uniformity Requirement, addresses CMS’ expectations for the MA plans regarding the reinterpretation of the “uniformity” requirements and how this flexibility will be applied to benefit offerings. The MA plans will be permitted to provide more targeted benefits to certain enrollees beginning in 2019.

In the 2019 MA Plan Call Letter, CMS announced its intention to redefine the scope of “primarily health related” supplemental benefits. CMS is expanding the definition of “primarily health related” to consider an item or service as primarily health related if it is used to diagnose, compensate for physical impairments, acts to ameliorate the functional/psychological impact of injuries or health conditions, or reduces avoidable emergency and healthcare utilization. The revised definition will permit the MA plans to provide services to its enrollees that, until now, have been considered tangentially related to health care.

In the memo, CMS provides a list of allowable benefits, but notes that it is not an exhaustive list.
  • Adult Day Care Services
  • Home -Based Palliative Care
  • In-Home Support Services
  • Support for Caregivers of Enrollees
  • Medically-Approved Non-Opioid Pain Management
  • Stand-alone Memory Fitness Benefit
  • Home & Bathroom Safety Devices & Modifications
  • Transportation
  • Over-the-Counter (OTC) Benefits
CMS expects the plans will establish reasonable safeguards to ensure enrollees are appropriately directed to care. CMS anticipates organizations will use this expanded definition to address health care needs and make adjustments to their annual supplemental benefit offerings based on the expected needs of their plan population.

Also in the 2019 Call Letter, CMS announced the reinterpretation of the uniformity requirements at §422.100(d), providing the MA plan with flexibility in order to offer targeted benefits. MA plans offering targeted benefits must provide access to services (or specific cost sharing and/or deductibles for services or items) that is tied to disease state in a manner that ensures that similarly situated individuals are treated uniformly. In doing so, the plan will be considered in compliance with the uniformity requirement.

The memo also addresses a demonstration project that is being conducted  on similar flexible requirements, known as the Medicare Advantage Value-Based Insurance Design Model (MA-VBID).

The National Association for Home Care & Hospice strongly supports CMS efforts in implementing innovative benefit offerings to MA plan enrollees. The expanded definition for health related supplemental benefits, in particular, will provide home health and hospice providers with unique opportunities to work with the MA plans in delivering comprehensive treatment plans for MA plan enrollees.

Iowa Center for Home Care members can direct questions to Julie Adair, IHCA VP, Home Care & Workforce, at 800.422.3106. 
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Education Calendar
NW District Meeting & Education, May 8, 2018, 10:00 a.m.-12:00 p.m., Storm Lake
SNF Medicare Review, May 9, 2018, West Des Moines
NE District Meeting & Education, May 10, 2018, 10:00 a.m.-12:00 p.m., Cedar Falls
Medicaid HCBS Elderly Waiver Review, May 16, West Des Moines
Assisted Living Nurses Conference, May 17, West Des Moines
SE District Meeting & Education, May 22, 2018, 10:00 a.m.-12:00 p.m., West Liberty
SW District Meeting & Education, May 24, 2018, 10:30 a.m.-12:30 p.m., Atlantic
Nursing Facility Reimbursement Conference, May 31, West Des Moines
LTC Medical Directors, Medical Practitioners & Pharmacists Conference, June 1-2, West Des Moines
Activity Professionals Workshop, June 14, Des Moines (See corrected date)
Summer Quarterly Education Conference, June 20, Des Moines
LTC Dietary Conference, June 26, West Des Moines
Assisted Living Management Certification, Online program
Online Dementia Care Training and Individual Certification Program
Click on the event link to learn more about each educational offering and to register. If you have additional questions, contact Georgene Olson at 800.422.3106.

West Des Moines area hotel discounts for IHCA members.

Map to the IHCA Education Center, 1775 90th Street, West Des Moines, IA.


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