A survey of U.S. Accountable Care Organizations (ACO) found that more than half of ACOs allowed beneficiaries to receive home-based care visits. | Image: Monkey Business / stock.adobe.com
In this edition
- CMS administrators ask Congress to improve Part B through BENES Act
- Biden campaign proposes public option plan run by traditional Medicare
- CMS urged to allow Medicare coverage for obesity drugs
- Legislation would waive face-to-face ordering requirement for home health
- Over half of ACOs offer home visits before COVID
- Indiana insurers offer Medigap to disabled beneficiaries
Welcome to Medicare Heads Up, a regular feature intended to deliver state and national Medicare-related headlines that will keep consumers abreast of developments that affect their coverage and costs. This week:
CMS administrators ask Congress to improve Part B through BENES Act
Congress may include Medicare enrollment rules changes in coronavirus relief legislation the Senate may consider when it returns from its recess next week.
A group of ten former CMS administrators from Democratic and Republican administrations asked Congress to pass the changes, known as the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280 / H.R. 2477) last week. The changes would shorten delays in effective dates and allow penalties to be waived for beneficiaries who make errors when enrolling in Medicare.
An increasing number of Americans are qualifying for Medicare at age 65 before they begin to collect Social Security benefits, and under current rules, this means they aren’t informed that they need to enroll in Medicare Part B unless they have insurance through a current job. Individuals who decline Part B and don’t have job-based coverage frequently end up with delayed medical coverage and late enrollment penalties once they do enroll.
The BENES Act would improve this situation for beneficiaries, by requiring the federal government to notify Americans about Medicare enrollment rules as they approach age 65. It would also align Medicare Part A and B enrollment periods with the existing open enrollment period for Medicare Advantage and Part D, and create a special enrollment period allowing people with COBRA to enroll in Part B.
Six Republicans and six Democrats in the Senate and seven Republicans and 11 Democrats in the House of Representatives have sponsored the legislation, which has been approved by key committees in the House.
Biden campaign proposes public option plan run by traditional Medicare
A task force created by Democratic presidential candidate Joe Biden and his former rival, Sen. Bernie Sanders, has released a set of policy proposals for the Democratic Party Convention platform that includes lowering the Medicare eligibility age from 65 to 60 years old.
Biden’s campaign is expected to adopt some of these positions as it courts younger and more liberal voters. The former Vice President first announced his support for lowering the age Americans qualify for Medicare in April.
The task force also proposed creating a public option health plan administered by the Original Medicare program as an alternative to private marketplace coverage. Americans ages 60 to 65 could choose between Medicare and the public option, which would be empowered to set prices the way Medicare does.
Although Biden previously supported a public option, this is the first proposal to specify it would be administered by Medicare.
CMS urged to allow Medicare coverage for obesity drugs
On July 1, Rep. Bill Cassidy (R-LA) and Sen. Thomas Carper (D-DE) sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma asking for Medicare Part D to begin covering anti-obesity medications, and for Medicare Part B to cover obesity counseling in more circumstances. Obesity is a risk factor for serious COVID disease, and severe obesity causes a 3.6 percent increase in the likelihood a COVID patient will need care such as mechanical ventilation, according to the letter.
Medicare Part D plans cannot currently cover anti-obesity medications under federal Medicare law, which forbids benefits for “anorexia, weight loss, or weight gain” drugs. Another treatment for obesity – Intensive Behavioral Therapy (IBT) – is currently covered only when received from a primary care provider.
The legislators are cosponsors of the Treat and Reduce Obesity Act (S.595), which would permit Part D plans to cover drug treatments for weight management, and allow more types of providers to offer IBT. But that legislation hasn’t come up for a vote since being introduced in 2013, and Cassidy and Carper’s letter argues CMS could also make the changes administratively.
Legislation would waive face-to-face ordering requirement for home health
Legislation introduced in the U.S. House of Representatives would decrease delays in ordering home health benefits due to the coronavirus by temporarily allowing providers to order those benefits after seeing patients virtually. Physicians presently have to see a patient in-person before ordering home health.
The Improving Home Health Services Act (H.R. 7006) would also permit nurse practitioners, physician assistants, and clinical nurse specialists to order home health services, which can currently only be ordered by physicians.
Eleven Democratic Representatives have cosponsored the legislation, which has been referred to the House Ways and Means and Energy and Commerce Committees. Neither committee has held a hearing.
Over half of ACOs offered home visits before COVID
A survey of 163 Accountable Care Organizations (ACO) around the U.S. found that as of late 2019, just over half of ACOs allowed beneficiaries to receive home-based care visits, and an additional 17 percent were planning to implement a home-based visit program in the near future. Home-based care providers initially struggled to partner with ACOs, but the survey data shows this trend is changing.
ACOs are partnerships of healthcare providers and insurers that work together to improve beneficiaries’ health and lower treatment costs. These partnerships began as an alternative to managed care in the Medicare program, but have expanded to include enrollees with private insurance and Medicaid.
Many ACOs cited primary care as their reason for offering home-based visits – and even more ACOs will likely adopt home-based visits now that the coronavirus crisis is causing beneficiaries to avoid medical offices. Beneficiaries interested in home-based services can ask whether their primary care provider offers those services individually or through an ACO.
Indiana insurers offer Medigap to disabled beneficiaries
Under an Indiana law that took effect July 1, 13 insurers in Indiana are offering Medigap plans to disabled Medicare beneficiaries. State legislation (SB 392) – passed in May 2019 – requires a Medigap insurer to offer at least Medigap Plan A to disabled Medicare beneficiaries if the insurer sells any Medigap plans to beneficiaries eligible for Medicare based on age. (Insurers are currently only offering Medigap Plan A to beneficiaries eligible under the legislation.)
Unlike similar legislation passed in several other states, Indiana’s law does not limit premiums for disabled beneficiaries, which means they might not be affordable for policyholders.
Indiana previously had not offered additional protections to individuals who are Medicare-eligible due to a disability. Because federal law does not require insurers to sell Medigap plans to Medicare beneficiaries under age 65, disabled beneficiaries in states without Medigap protections frequently have to enroll in Medicare Advantage for supplemental coverage.
Under the law, disabled Medicare beneficiaries will have a six-month open enrollment period, during which they can enroll in Medigap. That period normally begins when a beneficiary is enrolled in Part B or are determined retroactively eligible for it, but it started July 1, 2020 for beneficiaries who already have Part B coverage.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He also has held consulting roles, including as an associate at Sachs Policy Group, where he worked with insurer, hospital and technology clients on Medicare and Medicaid issues.