The acronym LTSS probably does not ring a bell with many retirees entering the Medicare age bracket. New enrollees are trying to understand the A- H plan differences. LTTS stands for Long Term Services and Supports and until now it was only a small part of the benefit for a small number of frailer recipients.  It includes many services you would think that older recipients would need.  If you went to your local state Health Department you would see the current status.

Home and community-based services vary by program and may include, but are not limited to, personal assistance, nursing, nurse monitoring, medical day care, case management, transportation, medical supplies and medical equipment. Long Term Services and Supports are mostly paid fee-for-service and are not covered by …. managed care organizations.

Well as of February 2018 a bipartisan budget bill, the Chronic Care Act passed and a much wider range of ancillary services can be made available with the newer Medicare advantage plans for 2020.  It stands for -hold your breath-Creating High-quality Results & Outcomes Necessary to Improve Chronic Care Act.

This means things like vision care, hearing aides, scooters, at home meals, special transportation, environmental adaptations (grab bars and ramps) as well as personal care and even adult day care  CAN be offered within the context of a Medicare Advantage plan. 

As with what looks like a step forward,  I take a step back to look at wider implications of policy. I am not a policy wonk but I am a what does this really mean thinker.  On the one hand the fact that this grew out of the CMS innovative program, CAPABLE  at John Hopkins in Baltimore where a nurse, an OT went into elders homes and obtained the agreement of the home owner as to what a home repair person could do to keep them independent and safe, is very positive. They obtained positive measurable results for people staying at home longer for a very reasonable amount of cost. I remember thinking at the time that this program needs to be cloned everywhere.

So fast forward to 2020 and people have bought into these plans…probably more expensive. Even now not all Advantage plans,  PART C all have silver sneakers and other benefits. It should give people choices. For now it changes nothing about traditional Medicare. 

BUT and there is also a caution when it comes to who really benefits…what about the fact that some plans could choose not offer it and cherry pick  supposedly healthier seniors who did not yet need most of these extra services?  What effect would that have on regular Medicare? As they reinterpret the definition of supplemental benefits, what does this really mean. Understand any increased costs would be  absorbed by the insurers and their enrollees -not the federal government. 

I approach all of this with a healthy dose of skepticism fueled by a great follow up article in the New England Journal of Medicinewritten in connection with John Hopkins, Titled …the Promises and Pitfalls of the Chronic Care Act: https://www.nejm.org/doi/full/10.1056/NEJMp1803292 

As the author puts it ,”the true benefits of this incremental step forward will depend largely on the will and effectiveness of the Medicare plans in integrating care.” This can be a win win situation where none medical intervention  prevents need for medical intervention.  

I would add and the insurance companies do use it as a screening tool for risk selection.  We buy insurance, house and car and even health plans hoping we will not need to use it. Insurance companies balance premiums and payouts.  The ancillary services are literally what most people who live to a ripe old age may need. 

Will the cost to finance most of this fall back on the consumer? 

Stay tuned.