A rising number of Medicare Advantage plans are offering home-based palliative care as a supplemental benefit. This year, 61 plans offer a palliative care benefit compared to 15 during 2019, a new Duke University report indicates.
Hospices provide about 50% of home-based palliative care in the United States according to the Center to Advance Palliative Care, and the number of providers that are diversifying their services lines to include palliative care continues to increase.
Through Medicare Advantage, the U.S. Centers for Medicare & Medicaid Services (CMS) contracts with private insurance companies to provide coverage for Medicare beneficiaries. Law requires Medicare Advantage plans to cover all of the services offered by traditional Medicare, but also allows for certain supplemental benefits.
Historically these benefits were very limited, but the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act (CHRONIC), passed by Congress in 2018, expanded the range of those benefits to include programs to address some social determinants of health as well as home-based palliative care.
The legislation also permitted Medicare Advantage plans to target specific populations among their enrollees to receive these benefits — such as those with serious illness or high-health care utilization — rather than offering the same benefits to all enrollees.
“Folks who have a serious or advanced illness but are still pre-hospice can start taking advantage of some of these [supplemental] benefits, like home-based palliative care or perhaps other types of palliative care, adult daycare and other types of services that may help them manage that stage of the disease, as well as hopefully encourage better conversations and end-of-life planning with their clinicians,” said Robert Saunders, research director for payment and delivery reform at Duke University’s Margolis Center for Health Policy, and co-author of the report.
In addition to palliative care, CMS allows Medicare Advantage plans to include adult day care services, caregiver support, medically approved non-opioid pain management, standalone memory fitness programs, and home safety devices and modifications in their suite of supplemental benefits, the Duke report indicated.
The increasing availability of these benefits may improve access to community-based palliative care nationwide, as well as those programs’ financial sustainability.
“We see this as a positive direction in the availability and sustainability of palliative care services,” Saunders told Hospice News. “Having greater coverage of palliative care services — especially those home-based palliative care services, or in-home support — should be useful and remove one barrier for people to access them.”
One challenge that hospice and palliative care providers may encounter is associated with the lack of a standardized definition for palliative care. Because each payer can develop its own definition, the specific services included in their palliative care benefit can vary widely.
One company’s plan may offer the full range of palliative care services in the home, provided by an interdisciplinary team; whereas a different Medicare Advantage plan may offer only a hospital-based consultation regarding the patient’s goals of care, the report’s authors found.
A concern for the plans themselves is that they can’t find enough palliative care providers to meet the growing demand.
“While the plans are offering these new benefits, there’s still a challenge in identifying providers who can actually deliver the services. Plans say that they are trying to offer home-based palliative care, but it’s hard to find sufficient numbers of providers, especially trained palliative care providers that can deliver those services,” Saunders said. “There’s also the challenge that simply offering services isn‘t enough. That’s got to be paired with plans working with the providers to communicate the options that are available to the beneficiaries and educating the beneficiaries and their families on those options.”
Currently, Medicare Advantage plans do not cover hospice care. Patients covered through Medicare Advantage members can elect the Medicare Hospice Benefit, which could cover any care pertaining to the patient’s terminal diagnosis. The patient’s Medicare Advantage plan would continue pay claims that are not associated with the terminal diagnosis.*
This too is on the road to change.
The Medicare Advantage hospice carve-in demonstration is set to begin Jan. 1, 2021. CMS recently opened the application period for the program. The carve-in, according to CMS, is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians.
It remains to be seen how the carve-in could impact the continuum of care that includes palliative care and hospice.
“One question that we have for the future is how these benefits will interface with the Medicare Advantage value-based insurance design pilot, which will allow Medicare Advantage plans to try offering hospice benefits directly,” Saunders told Hospice News. “There’s a question in our mind about how that will work when that rolls out in 2021, as well as how this might interface with other palliative care efforts.”
*Editor’s Note: This article initially said that patients had to end their Medicare Advantage coverage in order to enroll in the Medicare Hospice Benefit. This is incorrect, and the has been revised. Hospice News regrets the error.