5 Critical Changes Home Caregivers Need To Know About For 2020
When it comes to caring for your loved ones, you play the role of the expert: you know the routine, the daily ins and outs of care, and all the special touches that make a large difference in the health and well being of your family member. However, when it comes to being compensated for your time and effort, are you as well versed in the latest legislation and regulatory changes that could potentially have a huge impact on your paycheck? We compiled the top 5 critical changes you need to be aware of that are coming in 2020. Read more below to make sure you aren’t caught off guard and can start off the new year the right way.
1. PDGM is setting the pace for value-based care
PDGM (Patient-Driven Groupings Model) is a new change that’s coming to Medicare’s payment methodology in 2020, in fact, experts say that it’s the most significant change in over 20 years. Under this model, home care partners and agencies will be forced to take a microscope to every aspect of their business to make sure they are delivering efficient, high-quality care. This falls in line with the latest industry mindset of ‘deliver value, not volume’. So what does this mean for you? You will be able to be more selective than ever before when it comes to choosing a home care partner. These agencies are going to be striving to meet the satisfaction goals of the client/patient and patient/caregiver relationships, and that allows you to have the upper hand when it comes to choosing who you want to work with. The value that an agency provides is now more important than ever, and it will give caregivers the ability to be picky about who they partner with.
2. The definition of supplemental benefits is expanding (again)
In 2019, CMS (Centers for Medicare and Medicaid Services) implemented a series of rule changes aimed at bringing home care into the forefront of Medicare Advantage (MA). The first rule reinterpreted the standards for supplemental benefits by adding in the verbiage: “that increase health and improve quality of life, including coverage of non-skilled, in-home supports.” This year, they are expanding that definition even further to include any services that “address social determinants of health for people with chronic disease.” This change will allow home care partners to get creative with their benefits packages, and possibly bring in some extra perks for you as well.
3. More plans are coming and premiums are dropping
With CMS giving MA plans lots of new-found flexibility and leeway, more entrants are flocking to the market. This is great news for those with MA plans as premiums are expected to drop by 23%. Not only that, but with all the new players in the home care space, there will be about 1,200 more Medicare Advantage plans operating in 2020. According to Home Health Care News, “In 2020, 500 plans will offer up to 2.6 million MA beneficiaries supplemental benefits tailored to their needs to help them maintain their health, the Trump administration said. CMS first allowed the supplemental benefits — which include home care and adult day care — to be offered in the 2019 plan year. But in 2019, only 3% of plans offered such non-medical, in-home care benefits.” The bottom line? Expect companies to be competing for your business with extra supplemental benefits while you put some money back into your wallet.
4. RAP’s gone for good?
The Request for Anticipated Payouts (RAP) is on the chopping block in 2020. The existing split-percentage payment approach is proposed to go away in the rule. New HHAs, those certified on or after January 1, 2019, will not be able to submit for a RAP payment. However, they will still be required to submit a ‘‘no pay’’ RAP at the beginning of a period of care in order to establish the home health period of care, as well as every 30 days thereafter.
5. Mum’s the word about pain
When it comes to healthcare typically nothing is too taboo to talk about, but in one of the latest proposed changes, CMS wants to get rid of questions asking about a patient’s pain in their surveys. The logic here is that they want to help to eliminate the potentially unwanted consequences that have the ability to arise when looking at the survey answers. When it comes to Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS), for example, they would remove the question asking the patient ‘…did you and a home health provider from this agency talk about pain?’ ” Whether or not this will go into effect still remains to be seen, but patients will be able to discuss their pain without fear of being penalized.
Taking care of your loved one is just part of the equation – navigating the insurance and staying up to date on the ever-changing rules and regulations is the other. Make sure you are partnering with an agency that has your best interests in mind and will get you the best possible compensation.
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