Reimbursement for Daily Maintenance, Day Programs, and More
New Medicare Laws

Reimbursement for Daily Maintenance, Day Programs, and More

New Medicare Laws Allow Reimbursement for Daily Maintenance, Day Programs, Respite Care and More

The Centers for Medicare and Medicaid Services (CMS) recently announced non-skilled home care services, such as coverage for home safety devices, housekeeping, respite care for caregivers and adult day care services, will be covered in 2019.

The announcement marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage insurance plans. The agency reports, “CMS is expanding the definition of ‘primarily health related.’ Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

Coverage under Medicare Advantage will only apply if there is a health-related issue, such as a medical diagnosis. In its initial stages, the new Medicare Advantage plans will be available in over 20 states, but the Medicare Advantage coverage is expected to expand over time.

Some benefits will have no extra cost, while others will vary in cost and limits will apply in the reimbursement amount. For example, caregivers may be reimbursed for adult day programs, but only for two visits per week. Home care support services that will be covered include:

  • Adult day care services
  • Approved personnel to help with activities of daily living (ADLs)
  • Coverage for safety devices to prevent injuries in the home
  • In-home assistance for bathing, medication management etc.
  • Respite care for caregivers
  • Supportive services by personal care attendants

In a recent speech, CMS Administrator Seema Verma, states, “For the first time ever, Medicare Advantage beneficiaries can access significant new flexibility for additional benefits that can help them live healthier, more independent lives.” LIAF takes considerable pride in its pioneering role in the development of cutting-edge services that foster the independence, dignity, well-being and safety of individuals with Alzheimer's and other forms of dementia, thus aiding in the prevention of premature nursing home placement on Long Island. LIAF is here, every step of the way, to help caregivers and diagnosed individuals receive the guidance and comfort they deserve. Call today to learn more about our services, which may be covered by your insurance plans.

About the Author Long Island Alzheimer's Foundation

At the Long Island Alzheimer’s Foundation (LIAF) our mission is to improve the quality of life for those living with Alzheimer’s disease and related forms of dementia, and their caregivers. We actively work to achieve this mission through research-based programming for all stages of Alzheimer’s, Caregiver Support Groups, in-home respite solutions, transportation options, and additional services.

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