NAHC/HHFMA Medicare Advantage Survey - 2024

The National Association for Home Care & Hospice (NAHC), in conjunction with the Home Care & Hospice Financial Managers Association (HHFMA), has developed a survey to assess the current state of home health within Medicare Advantage (MA) plans.

We are asking home health providers that contract with MA plans to complete this survey, estimated at about 10-15 minutes. Thank you in advance for your participation.

Question Title

* 1. In which state(s) and territories does your company provide home health care? Please list only one State or territory and complete a separate survey for each state or territory where you provide MA Plan services.

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

District of Columbia

Delaware

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Question Title

* 2. What percentage of your patient mix is made up of traditional Medicare patients?

0 - 10%

11 - 20%

21 - 30%

31 - 40%

41 - 50%

51 - 60%

61 - 70%

71 - 80%

81 - 90%

91 - 100%

Question Title

* 3. What percentage of your patient mix is made up of Medicare Advantage patients?

0 - 10%

11 - 20%

21 - 30%

31 - 40%

41 - 50%

51 - 60%

61 - 70%

71 - 80%

81 - 90%

91 - 100%

Question Title

* 4. What percentage of your revenue comes from traditional Medicare and Medicare Advantage?

	Traditional Medicare	Medicare Advantage
None	None Traditional Medicare	None Medicare Advantage
0-20%	0-20% Traditional Medicare	0-20% Medicare Advantage
21-40%	21-40% Traditional Medicare	21-40% Medicare Advantage
41-60%	41-60% Traditional Medicare	41-60% Medicare Advantage
Above 60%	Above 60% Traditional Medicare	Above 60% Medicare Advantage

Question Title

* 5. What percentage of your revenue comes from Medicaid?

	Traditional Medicaid	Waiver Programs	Medicaid Managed Care (HMO, etc.)
0-20%	0-20% Traditional Medicaid	0-20% Waiver Programs	0-20% Medicaid Managed Care (HMO, etc.)
21 - 40%	21 - 40% Traditional Medicaid	21 - 40% Waiver Programs	21 - 40% Medicaid Managed Care (HMO, etc.)
41 - 60%	41 - 60% Traditional Medicaid	41 - 60% Waiver Programs	41 - 60% Medicaid Managed Care (HMO, etc.)
Above 60%	Above 60% Traditional Medicaid	Above 60% Waiver Programs	Above 60% Medicaid Managed Care (HMO, etc.)

Question Title

* 6. Describe your company (check all that apply)

Freestanding

Institution-based (hospital/SNF)

Health system affiliated

Government-based

For-profit

Non-profit

Rural

Urban

Rural and Urban

Question Title

* 7. The following questions relate to the top 5 Medicare Advantage plans, by visit volume, that you do business with. Please list the top 5 plans.

Plan 1

Plan 2

Plan 3

Plan 4

Plan 5

Question Title

* 8. What is the reimbursement method that the MA plan uses for home health services?

	PDGM	PPS (as existed pre-PDGM)	Per visit	Other
Plan 1	Plan 1 PDGM	Plan 1 PPS (as existed pre-PDGM)	Plan 1 Per visit	Plan 1 Other
Plan 2	Plan 2 PDGM	Plan 2 PPS (as existed pre-PDGM)	Plan 2 Per visit	Plan 2 Other
Plan 3	Plan 3 PDGM	Plan 3 PPS (as existed pre-PDGM)	Plan 3 Per visit	Plan 3 Other
Plan 4	Plan 4 PDGM	Plan 4 PPS (as existed pre-PDGM)	Plan 4 Per visit	Plan 4 Other
Plan 5	Plan 5 PDGM	Plan 5 PPS (as existed pre-PDGM)	Plan 5 Per visit	Plan 5 Other

Other (please specify)

Question Title

* 9. If the plan exclusively reimburses with per visit payment, how do those visit rates compare with your Medicare LUPA rate?

	> 10% less than LUPA	6 - 10% less than LUPA	0 - 5% less than LUPA	LUPA Rates	0 - 5% greater than LUPA	6 - 10% greater than LUPA	> 10% greater than LUPA	Not applicable
Plan 1	Plan 1 > 10% less than LUPA	Plan 1 6 - 10% less than LUPA	Plan 1 0 - 5% less than LUPA	Plan 1 LUPA Rates	Plan 1 0 - 5% greater than LUPA	Plan 1 6 - 10% greater than LUPA	Plan 1 > 10% greater than LUPA	Plan 1 Not applicable
Plan 2	Plan 2 > 10% less than LUPA	Plan 2 6 - 10% less than LUPA	Plan 2 0 - 5% less than LUPA	Plan 2 LUPA Rates	Plan 2 0 - 5% greater than LUPA	Plan 2 6 - 10% greater than LUPA	Plan 2 > 10% greater than LUPA	Plan 2 Not applicable
Plan 3	Plan 3 > 10% less than LUPA	Plan 3 6 - 10% less than LUPA	Plan 3 0 - 5% less than LUPA	Plan 3 LUPA Rates	Plan 3 0 - 5% greater than LUPA	Plan 3 6 - 10% greater than LUPA	Plan 3 > 10% greater than LUPA	Plan 3 Not applicable
Plan 4	Plan 4 > 10% less than LUPA	Plan 4 6 - 10% less than LUPA	Plan 4 0 - 5% less than LUPA	Plan 4 LUPA Rates	Plan 4 0 - 5% greater than LUPA	Plan 4 6 - 10% greater than LUPA	Plan 4 > 10% greater than LUPA	Plan 4 Not applicable
Plan 5	Plan 5 > 10% less than LUPA	Plan 5 6 - 10% less than LUPA	Plan 5 0 - 5% less than LUPA	Plan 5 LUPA Rates	Plan 5 0 - 5% greater than LUPA	Plan 5 6 - 10% greater than LUPA	Plan 5 > 10% greater than LUPA	Plan 5 Not applicable

Question Title

* 10. If the plan exclusively reimburses on an episode basis, what is the payment rate?

	> 10% less than PDGM/PPS	6 - 10% less than PDGM/PPS	0 - 5% less than PDGM/PPS	PDGM/PPS Rates	0 - 5% greater than PDGM/PPS	6 - 10% greater than PDGM/PPS	> 10% greater than PDGM/PPS	Not applicable
Plan 1	Plan 1 > 10% less than PDGM/PPS	Plan 1 6 - 10% less than PDGM/PPS	Plan 1 0 - 5% less than PDGM/PPS	Plan 1 PDGM/PPS Rates	Plan 1 0 - 5% greater than PDGM/PPS	Plan 1 6 - 10% greater than PDGM/PPS	Plan 1 > 10% greater than PDGM/PPS	Plan 1 Not applicable
Plan 2	Plan 2 > 10% less than PDGM/PPS	Plan 2 6 - 10% less than PDGM/PPS	Plan 2 0 - 5% less than PDGM/PPS	Plan 2 PDGM/PPS Rates	Plan 2 0 - 5% greater than PDGM/PPS	Plan 2 6 - 10% greater than PDGM/PPS	Plan 2 > 10% greater than PDGM/PPS	Plan 2 Not applicable
Plan 3	Plan 3 > 10% less than PDGM/PPS	Plan 3 6 - 10% less than PDGM/PPS	Plan 3 0 - 5% less than PDGM/PPS	Plan 3 PDGM/PPS Rates	Plan 3 0 - 5% greater than PDGM/PPS	Plan 3 6 - 10% greater than PDGM/PPS	Plan 3 > 10% greater than PDGM/PPS	Plan 3 Not applicable
Plan 4	Plan 4 > 10% less than PDGM/PPS	Plan 4 6 - 10% less than PDGM/PPS	Plan 4 0 - 5% less than PDGM/PPS	Plan 4 PDGM/PPS Rates	Plan 4 0 - 5% greater than PDGM/PPS	Plan 4 6 - 10% greater than PDGM/PPS	Plan 4 > 10% greater than PDGM/PPS	Plan 4 Not applicable
Plan 5	Plan 5 > 10% less than PDGM/PPS	Plan 5 6 - 10% less than PDGM/PPS	Plan 5 0 - 5% less than PDGM/PPS	Plan 5 PDGM/PPS Rates	Plan 5 0 - 5% greater than PDGM/PPS	Plan 5 6 - 10% greater than PDGM/PPS	Plan 5 > 10% greater than PDGM/PPS	Plan 5 Not applicable

Question Title

* 11. If the plan utilizes PDGM/PPS reimbursement, what billing/claim format do you use?

	RAP and Final claim	Final claim only	Unknown	Not applicable
Plan 1	Plan 1 RAP and Final claim	Plan 1 Final claim only	Plan 1 Unknown	Plan 1 Not applicable
Plan 2	Plan 2 RAP and Final claim	Plan 2 Final claim only	Plan 2 Unknown	Plan 2 Not applicable
Plan 3	Plan 3 RAP and Final claim	Plan 3 Final claim only	Plan 3 Unknown	Plan 3 Not applicable
Plan 4	Plan 4 RAP and Final claim	Plan 4 Final claim only	Plan 4 Unknown	Plan 4 Not applicable
Plan 5	Plan 5 RAP and Final claim	Plan 5 Final claim only	Plan 5 Unknown	Plan 5 Not applicable

Question Title

* 12. What is the billing timeliness requirement for the plan?

	30 days or less	Between 30 and 90 days	90 days	180 days	1 year	No limit	Other
Plan 1	Plan 1 30 days or less	Plan 1 Between 30 and 90 days	Plan 1 90 days	Plan 1 180 days	Plan 1 1 year	Plan 1 No limit	Plan 1 Other
Plan 2	Plan 2 30 days or less	Plan 2 Between 30 and 90 days	Plan 2 90 days	Plan 2 180 days	Plan 2 1 year	Plan 2 No limit	Plan 2 Other
Plan 3	Plan 3 30 days or less	Plan 3 Between 30 and 90 days	Plan 3 90 days	Plan 3 180 days	Plan 3 1 year	Plan 3 No limit	Plan 3 Other
Plan 4	Plan 4 30 days or less	Plan 4 Between 30 and 90 days	Plan 4 90 days	Plan 4 180 days	Plan 4 1 year	Plan 4 No limit	Plan 4 Other
Plan 5	Plan 5 30 days or less	Plan 5 Between 30 and 90 days	Plan 5 90 days	Plan 5 180 days	Plan 5 1 year	Plan 5 No limit	Plan 5 Other

Other (please specify)

Question Title

* 13. What is the average number of days from claim submission to payment receipt?

	<30 days	30-45 days	46-60 days	61-90 days	>90 days	Unknown
Plan 1	Plan 1 <30 days	Plan 1 30-45 days	Plan 1 46-60 days	Plan 1 61-90 days	Plan 1 >90 days	Plan 1 Unknown
Plan 2	Plan 2 <30 days	Plan 2 30-45 days	Plan 2 46-60 days	Plan 2 61-90 days	Plan 2 >90 days	Plan 2 Unknown
Plan 3	Plan 3 <30 days	Plan 3 30-45 days	Plan 3 46-60 days	Plan 3 61-90 days	Plan 3 >90 days	Plan 3 Unknown
Plan 4	Plan 4 <30 days	Plan 4 30-45 days	Plan 4 46-60 days	Plan 4 61-90 days	Plan 4 >90 days	Plan 4 Unknown
Plan 5	Plan 5 <30 days	Plan 5 30-45 days	Plan 5 46-60 days	Plan 5 61-90 days	Plan 5 >90 days	Plan 5 Unknown

Question Title

* 14. What percentage of claims are paid after the first claim submission?

	<50%	50-75%	76-85%	86-95%	>95%	Unknown
Plan 1	Plan 1 <50%	Plan 1 50-75%	Plan 1 76-85%	Plan 1 86-95%	Plan 1 >95%	Plan 1 Unknown
Plan 2	Plan 2 <50%	Plan 2 50-75%	Plan 2 76-85%	Plan 2 86-95%	Plan 2 >95%	Plan 2 Unknown
Plan 3	Plan 3 <50%	Plan 3 50-75%	Plan 3 76-85%	Plan 3 86-95%	Plan 3 >95%	Plan 3 Unknown
Plan 4	Plan 4 <50%	Plan 4 50-75%	Plan 4 76-85%	Plan 4 86-95%	Plan 4 >95%	Plan 4 Unknown
Plan 5	Plan 5 <50%	Plan 5 50-75%	Plan 5 76-85%	Plan 5 86-95%	Plan 5 >95%	Plan 5 Unknown

Question Title

* 15. Check the box if the plan requires the following traditional Medicare documentation.

	Physician face-to-face documentation	Clinical visit documentation	Other
Plan 1	Plan 1 Physician face-to-face documentation	Plan 1 Clinical visit documentation	Plan 1 Other
Plan 2	Plan 2 Physician face-to-face documentation	Plan 2 Clinical visit documentation	Plan 2 Other
Plan 3	Plan 3 Physician face-to-face documentation	Plan 3 Clinical visit documentation	Plan 3 Other
Plan 4	Plan 4 Physician face-to-face documentation	Plan 4 Clinical visit documentation	Plan 4 Other
Plan 5	Plan 5 Physician face-to-face documentation	Plan 5 Clinical visit documentation	Plan 5 Other

Other (please specify)

Question Title

* 16. How do you determine patient coverage/eligibility for the plans?

	3rd party vendor	Website	Telephone	Other
Plan 1	Plan 1 3rd party vendor	Plan 1 Website	Plan 1 Telephone	Plan 1 Other
Plan 2	Plan 2 3rd party vendor	Plan 2 Website	Plan 2 Telephone	Plan 2 Other
Plan 3	Plan 3 3rd party vendor	Plan 3 Website	Plan 3 Telephone	Plan 3 Other
Plan 4	Plan 4 3rd party vendor	Plan 4 Website	Plan 4 Telephone	Plan 4 Other
Plan 5	Plan 5 3rd party vendor	Plan 5 Website	Plan 5 Telephone	Plan 5 Other

Other (please specify)

Question Title

* 17. Have you had eligibility determination problems/errors with the plan?

	Yes	No
Plan 1	Plan 1 Yes	Plan 1 No
Plan 2	Plan 2 Yes	Plan 2 No
Plan 3	Plan 3 Yes	Plan 3 No
Plan 4	Plan 4 Yes	Plan 4 No
Plan 5	Plan 5 Yes	Plan 5 No

If yes, please explain

Question Title

* 18. Does the plan require pre-authorization for services to be provided and paid?

	Yes	Yes, in certain circumstances	No	Unknown
Plan 1	Plan 1 Yes	Plan 1 Yes, in certain circumstances	Plan 1 No	Plan 1 Unknown
Plan 2	Plan 2 Yes	Plan 2 Yes, in certain circumstances	Plan 2 No	Plan 2 Unknown
Plan 3	Plan 3 Yes	Plan 3 Yes, in certain circumstances	Plan 3 No	Plan 3 Unknown
Plan 4	Plan 4 Yes	Plan 4 Yes, in certain circumstances	Plan 4 No	Plan 4 Unknown
Plan 5	Plan 5 Yes	Plan 5 Yes, in certain circumstances	Plan 5 No	Plan 5 Unknown

Question Title

* 19. What is the nature of the authorization process?

	Automated (secure web-based)	Fax	Mail	Telephone	Unknown	Not applicable	Other
Plan 1	Plan 1 Automated (secure web-based)	Plan 1 Fax	Plan 1 Mail	Plan 1 Telephone	Plan 1 Unknown	Plan 1 Not applicable	Plan 1 Other
Plan 2	Plan 2 Automated (secure web-based)	Plan 2 Fax	Plan 2 Mail	Plan 2 Telephone	Plan 2 Unknown	Plan 2 Not applicable	Plan 2 Other
Plan 3	Plan 3 Automated (secure web-based)	Plan 3 Fax	Plan 3 Mail	Plan 3 Telephone	Plan 3 Unknown	Plan 3 Not applicable	Plan 3 Other
Plan 4	Plan 4 Automated (secure web-based)	Plan 4 Fax	Plan 4 Mail	Plan 4 Telephone	Plan 4 Unknown	Plan 4 Not applicable	Plan 4 Other
Plan 5	Plan 5 Automated (secure web-based)	Plan 5 Fax	Plan 5 Mail	Plan 5 Telephone	Plan 5 Unknown	Plan 5 Not applicable	Plan 5 Other

Other (please specify)

Question Title

* 20. What is the average length of time for initial authorization following initial request?

	Less than an hour	Between 1 and 24 hours	Between 25 and 48 hours	Between 3 and 5 days	More than 5 days
Plan 1	Plan 1 Less than an hour	Plan 1 Between 1 and 24 hours	Plan 1 Between 25 and 48 hours	Plan 1 Between 3 and 5 days	Plan 1 More than 5 days
Plan 2	Plan 2 Less than an hour	Plan 2 Between 1 and 24 hours	Plan 2 Between 25 and 48 hours	Plan 2 Between 3 and 5 days	Plan 2 More than 5 days
Plan 3	Plan 3 Less than an hour	Plan 3 Between 1 and 24 hours	Plan 3 Between 25 and 48 hours	Plan 3 Between 3 and 5 days	Plan 3 More than 5 days
Plan 4	Plan 4 Less than an hour	Plan 4 Between 1 and 24 hours	Plan 4 Between 25 and 48 hours	Plan 4 Between 3 and 5 days	Plan 4 More than 5 days
Plan 5	Plan 5 Less than an hour	Plan 5 Between 1 and 24 hours	Plan 5 Between 25 and 48 hours	Plan 5 Between 3 and 5 days	Plan 5 More than 5 days

Question Title

* 21. For initial weekend authorizations:

	Provides Weekend authorizations	Has delays in weekend authorizations (one full day or more)
Plan 1	Plan 1 Provides Weekend authorizations	Plan 1 Has delays in weekend authorizations (one full day or more)
Plan 2	Plan 2 Provides Weekend authorizations	Plan 2 Has delays in weekend authorizations (one full day or more)
Plan 3	Plan 3 Provides Weekend authorizations	Plan 3 Has delays in weekend authorizations (one full day or more)
Plan 4	Plan 4 Provides Weekend authorizations	Plan 4 Has delays in weekend authorizations (one full day or more)
Plan 5	Plan 5 Provides Weekend authorizations	Plan 5 Has delays in weekend authorizations (one full day or more)

Question Title

* 22. If the plan requires a reauthorization of care periodically, at what frequency is reauthorization required?

	Every 15 days	Every 30 days	Every 60 days	Varies based on previous authorization	Other	Not applicable
Plan 1	Plan 1 Every 15 days	Plan 1 Every 30 days	Plan 1 Every 60 days	Plan 1 Varies based on previous authorization	Plan 1 Other	Plan 1 Not applicable
Plan 2	Plan 2 Every 15 days	Plan 2 Every 30 days	Plan 2 Every 60 days	Plan 2 Varies based on previous authorization	Plan 2 Other	Plan 2 Not applicable
Plan 3	Plan 3 Every 15 days	Plan 3 Every 30 days	Plan 3 Every 60 days	Plan 3 Varies based on previous authorization	Plan 3 Other	Plan 3 Not applicable
Plan 4	Plan 4 Every 15 days	Plan 4 Every 30 days	Plan 4 Every 60 days	Plan 4 Varies based on previous authorization	Plan 4 Other	Plan 4 Not applicable
Plan 5	Plan 5 Every 15 days	Plan 5 Every 30 days	Plan 5 Every 60 days	Plan 5 Varies based on previous authorization	Plan 5 Other	Plan 5 Not applicable

Are there additional documentation requirements for reauthorization?

Question Title

* 23. Does the plan permit retroactive authorizations?

	Yes	No	Sometimes	Unknown	Not applicable
Plan 1	Plan 1 Yes	Plan 1 No	Plan 1 Sometimes	Plan 1 Unknown	Plan 1 Not applicable
Plan 2	Plan 2 Yes	Plan 2 No	Plan 2 Sometimes	Plan 2 Unknown	Plan 2 Not applicable
Plan 3	Plan 3 Yes	Plan 3 No	Plan 3 Sometimes	Plan 3 Unknown	Plan 3 Not applicable
Plan 4	Plan 4 Yes	Plan 4 No	Plan 4 Sometimes	Plan 4 Unknown	Plan 4 Not applicable
Plan 5	Plan 5 Yes	Plan 5 No	Plan 5 Sometimes	Plan 5 Unknown	Plan 5 Not applicable

Question Title

* 24. For MA cases, what percentage of your organization’s requests for initial authorization are denied?

	0%	Less than 5%	5-10%	11-20%	Greater than 20%	Unknown
Plan 1	Plan 1 0%	Plan 1 Less than 5%	Plan 1 5-10%	Plan 1 11-20%	Plan 1 Greater than 20%	Plan 1 Unknown
Plan 2	Plan 2 0%	Plan 2 Less than 5%	Plan 2 5-10%	Plan 2 11-20%	Plan 2 Greater than 20%	Plan 2 Unknown
Plan 3	Plan 3 0%	Plan 3 Less than 5%	Plan 3 5-10%	Plan 3 11-20%	Plan 3 Greater than 20%	Plan 3 Unknown
Plan 4	Plan 4 0%	Plan 4 Less than 5%	Plan 4 5-10%	Plan 4 11-20%	Plan 4 Greater than 20%	Plan 4 Unknown
Plan 5	Plan 5 0%	Plan 5 Less than 5%	Plan 5 5-10%	Plan 5 11-20%	Plan 5 Greater than 20%	Plan 5 Unknown

Question Title

* 25. For MA cases, what percentage of your organization’s requests for ongoing authorization are denied?

	0%	Less than 5%	5-10%	11-20%	Greater than 20%	Unknown
Plan 1	Plan 1 0%	Plan 1 Less than 5%	Plan 1 5-10%	Plan 1 11-20%	Plan 1 Greater than 20%	Plan 1 Unknown
Plan 2	Plan 2 0%	Plan 2 Less than 5%	Plan 2 5-10%	Plan 2 11-20%	Plan 2 Greater than 20%	Plan 2 Unknown
Plan 3	Plan 3 0%	Plan 3 Less than 5%	Plan 3 5-10%	Plan 3 11-20%	Plan 3 Greater than 20%	Plan 3 Unknown
Plan 4	Plan 4 0%	Plan 4 Less than 5%	Plan 4 5-10%	Plan 4 11-20%	Plan 4 Greater than 20%	Plan 4 Unknown
Plan 5	Plan 5 0%	Plan 5 Less than 5%	Plan 5 5-10%	Plan 5 11-20%	Plan 5 Greater than 20%	Plan 5 Unknown

Question Title

* 26. What percentage of MA cases for whom authorization had been achieved was subsequently denied?

	0%	Less than 5%	5-10%	11-20%	Greater than 20%	Other	Unknown
Plan 1	Plan 1 0%	Plan 1 Less than 5%	Plan 1 5-10%	Plan 1 11-20%	Plan 1 Greater than 20%	Plan 1 Other	Plan 1 Unknown
Plan 2	Plan 2 0%	Plan 2 Less than 5%	Plan 2 5-10%	Plan 2 11-20%	Plan 2 Greater than 20%	Plan 2 Other	Plan 2 Unknown
Plan 3	Plan 3 0%	Plan 3 Less than 5%	Plan 3 5-10%	Plan 3 11-20%	Plan 3 Greater than 20%	Plan 3 Other	Plan 3 Unknown
Plan 4	Plan 4 0%	Plan 4 Less than 5%	Plan 4 5-10%	Plan 4 11-20%	Plan 4 Greater than 20%	Plan 4 Other	Plan 4 Unknown
Plan 5	Plan 5 0%	Plan 5 Less than 5%	Plan 5 5-10%	Plan 5 11-20%	Plan 5 Greater than 20%	Plan 5 Other	Plan 5 Unknown

Other (please specify)

Question Title

* 27. What percentage of your organization’s denied (initial and ongoing) prior authorizations are overturned (where overturned means denial followed by payment being achieved) on appeal?

	0-25%	26-50%	51-75%	76-100%	Unknown
Plan 1	Plan 1 0-25%	Plan 1 26-50%	Plan 1 51-75%	Plan 1 76-100%	Plan 1 Unknown
Plan 2	Plan 2 0-25%	Plan 2 26-50%