An Adult Day 'Win'

Positive news for adult day providers in the final rule for Medicare Program: Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Changes that was recently released.

We are pleased that CMS concurred with LeadingAge’s position that Medicare should allow dual eligible Special Needs managed care Plans (D-SNPs) to offer additional supplemental home and community-based benefits, such as adult day services to its eligible subscribers beyond those supplemental benefits MA plans are allowed to offer.

Thank you to the large number of LeadingAge members that submitted comments requesting that CMS include adult day care services as a category of supplemental benefits that plans would be permitted to offer under this new supplemental benefit flexibility.

LeadingAge has contacted CMS and provided them with more information about the scope of services and payment sources for adult day services.

CMS believes that qualifying Dual-Eligible Special Need Medicare Advantage Plans granted this supplemental benefit flexibility could help prevent health status decline and reduce the quantity and cost of future health care needs.

We also encouraged CMS to incorporate information on the use of adult day services in their operational guidance for dual eligible special need Medicare Advantage care plans.