ACOs: 6 Home Care, Hospice, and Telehealth Benefit Waivers

The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, a program from CMS, is testing home care benefits, hospice benefits, and telehealth, as well as who can perform home care visits.

These six transformative home care, hospice, and telehealth benefits being tested allow CMS to waive select Medicare payment requirements.

The key benefits being tested and waived under this model: (Scott please provide spacing between bullets).

1. Home Health for Non-Homebound Patients: This benefit allows Medicare to reimburse home health services for beneficiaries with certain clinical risk factors who are not strictly homebound, expanding access to home health care for more patients.
2. Post-Discharge and Care Management Home Visits: Normally, these visits must be supervised directly by a physician. Under the ACO REACH Model, they can be provided under general supervision, thus using auxiliary personnel to deliver the service, which can enhance care management and reduce the burden on physicians.
3. Concurrent Care for Hospice Patients: Beneficiaries who elect hospice care typically waive Medicare coverage for curative treatments. Under the new model, ACOs can provide a set of concurrent care services, allowing for both hospice and certain curative treatments to be covered simultaneously.
4. 3-Day SNF Rule Waiver: Typically, Medicare beneficiaries must have a three-day inpatient hospital stay before receiving Medicare-covered Skilled Nursing Facility (SNF) services. The ACO REACH Model allows beneficiaries to receive these services without the three-day requirement, which can improve access to necessary care more promptly.
5. Telehealth Flexibilities: This includes the removal of the rural geographic component of originating site requirements, allowing a beneficiary’s home to be the originating site, and permitting the use of asynchronous telehealth services for specialties like teledermatology and teleophthalmology.
6. NP Services Expansion: Nurse practitioners are authorized to certify the need for hospice care, order and supervise cardiac rehabilitation, and perform other critical tasks, which can streamline processes and improve patient care efficiency.

All benefit enhancements updates are effective July 1, 2023.

The New Roles Of Nurse Practitioners And Physician Assistants Are Expanded

The Nurse Practitioner (NP) Services Benefit Enhancement allows for five services to be delivered by NPs, increasing the flexibility of care delivery:

1. Hospice Care Certification
2. Certification of Need for Diabetic Shoes
3. Certification of Cardiac Rehabilitation Care Plan
4. Certification of Plan of Care for Home Infusion Therapy
5. Referrals for Medical Nutrition Therapy

Physician assistants (PAs) can:

• Allow personnel other than physicians to provide post-discharge and care management home visits.
• Permit reimbursable home health even if the beneficiary is not homebound if they meet certain clinical risk factors.
• Provide previously prohibited curative services alongside palliative care for people in hospice.
• Waive the skilled nursing facility (SNF) requirement that admission be preceded by a three-day inpatient hospital stay.

The Advancement Of  Health Equity To Bring The Benefits Of Accountable Care To Underserved Communities

The ACO Reach Model promotes health equity and focuses on bringing the benefits of accountable care to Medicare beneficiaries in underserved communities. CMS will use an innovative payment approach to better support care delivery and coordination for patients in underserved communities and will require that all model participants develop and implement a robust health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities within their beneficiary populations.

The ACO Reach Model is introducing five new policies to promote health equity started in PY2023:

• Health Equity Plan Requirement.
• Health Equity Benchmark Adjustment.
• Health Equity Data Collection Requirement.
• Nurse Practitioner Services Benefit Enhancement.
• Health Equity Questions in Application and Scoring for Health Equity Experience.

The ACO REACH Model, started on January 1, 2023 and will span four Performance Years, ending on December 31, 2026.