CMS Round Up
CMS Roundup (Dec. 15, 2023)
Today, the Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.
CMS Releases Guidance to States on Reporting Requirements on Annual Reporting of Medicaid & CHIP Quality Measures
December 1: CMS released guidance to states to promote consistent use of nationally standardized data in Medicaid and Children’s Health Insurance Program (CHIP) to identify gaps and health disparities among the millions of people enrolled in these programs. The guidance includes requirements and expectations for compliance with mandatory, annual state reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set) and the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set). Mandatory reporting requirements apply to all states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam due to a CMS final rule released on August 31, 2023, and the Biden-Harris Administration’s commitment to getting and keeping people covered.
CMS Issues 2023 Measures Under Consideration for Adoption Through Medicare Rulemaking
December 1: As required by statute, CMS issued the 2023 Measures Under Consideration (MUC) List. Ninety-five percent of the 42 measures on the List use digital data sources, advancing the CMS National Quality Strategy goal of prioritizing the development of interoperable and digital quality measures. Additionally, ten measures address person-centered care, accelerating equity and engagement for all individuals. CMS makes these measures publicly available to seek input. Information on the process, including deadlines, can be found here.
CMS Approves Mobile Crisis Services for People with Medicaid in Colorado
December 4: CMS approved a state plan amendment (SPA) for mobile crisis services in Colorado. Authorized under President Biden’s American Rescue Plan (ARP), mobile crisis intervention services provide rapid, critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option helps states integrate these services into their Medicaid programs, a critical component in establishing a sustainable, public health-focused support network. This is the 14th mobile crisis SPA approved by CMS.
CMS Posts Fact Sheet Highlighting Accomplishments to Improve Safety and Quality of Life in Long-Term Care Settings
December 5: As part of the Biden-Harris Administration’s commitment to improving safety and quality of life in long-term care settings, CMS posted the Nursing Homes and Choice in Long- Term Care Cross Cutting Initiative fact sheet. The fact sheet provides an overview of recent accomplishments and ongoing actions to improve the safety and quality of care for nursing home residents, strengthen accountability for facilities, and increase public transparency around quality and ownership information. CMS is equally committed to expanding access to care for home- and community-based services and will continue efforts to ensure people receive high-quality long-term services and support in the appropriate setting of their choice.
CMS Announces Date for the 2024 CMS Health Equity Conference
December 5: CMS announced its second annual CMS Health Equity Conference will take place May 29-30, 2024. The free, hybrid conference will be held in person at the Hyatt Regency hotel in Bethesda, Maryland, and available online for virtual participation. Building on last year’s inaugural event, the 2024 CMS Health Equity Conference will convene health equity leaders from federal and local agencies, health provider organizations, academia, community-based organizations, and others. Conference attendees will have the opportunity to hear from CMS leadership on recent developments and updates to CMS programs; explore the latest health equity research; discuss promising practices and creative solutions; and collaborate on community engagement strategies.
CMS Approves Missouri’s Substance Use Disorder & Serious Mental Illness Section 1115 Demonstration
December 6: CMS approved Missouri’s Substance Use Disorder (SUD) and Serious Mental Illness (SMI) section 1115 demonstration request. This approval authorizes the state to receive federal financial participation for providing otherwise covered services for treatment of SUD and/or SMI to individuals with Medicaid ages 21-64 who are short-term residents in settings in which such services would not otherwise be covered because the settings qualify as institutions for mental diseases. Through this demonstration, both Missouri and the Biden-Harris Administration seek to advance efforts to address behavioral and mental health care needs at the state level.
CMS Releases Three New Data Briefs on Enrollees in Medicaid and CHIP
December 7: CMS released data briefs about characteristics of enrollees in Medicaid and the Children’s Health Insurance Program (CHIP). The three data briefs focus on enrollees who received mental health or substance use disorder services, had well child visits, and received long-term care services at home or in a community-based setting under the Medicaid 1915 (c) waiver program in 2020. These new data briefs build on a series of data briefs released earlier in 2023 that used first-ever national estimates of the demographic composition of Medicaid and CHIP, including analyses stratified by race, ethnicity, primary language, geography, and eligibility based on disability. These data briefs help describe the demographic makeup of program enrollees and provide a richer picture of the individuals served by Medicaid and CHIP, which together constitute some of the nation’s largest and most vital health coverage programs. Understanding the needs of individuals who rely on these services is part of the Biden-Harris Administration’s efforts to make coverage better for the people served by our programs.
CMS Accepting Public Comment on Proposed NCD for Allogeneic Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndromes
December 7: CMS announced a proposed decision regarding the existing national coverage determination (NCD) for Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS). The proposed decision would remove the Coverage with Evidence Development (CED) requirement currently tied to coverage for HSCT for Medicare beneficiaries with MDS. It would expand national coverage for certain beneficiaries. Information can be found here.
CMS Releases Ownership Data for Rural Health Clinics & Federally Qualified Health Centers
December 7: CMS released full ownership data for Rural Health Clinics and Federally Qualified Health Centers. This is a continuation of previous ownership data releases, including change of ownership data and full ownership data for hospitals, skilled nursing facilities, home health agencies, and hospices. Making ownership information transparent benefits researchers and enforcement agencies by allowing them to identify familiar owners that have had histories of poor performance, analyze data and trends on how market consolidation impacts consumers with increased costs without necessarily improving quality of care, and evaluate the relationships between ownership and changes in health care costs and outcomes.
CMS Approves Postpartum Coverage Extensions for Nebraska & Mississippi
CMS recently approved state plan amendments (SPAs) to extend postpartum coverage to a full year for individuals enrolled in Medicaid in Nebraska (December 8) and individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in Mississippi (December 13). The opportunity to extend postpartum coverage is made possible by the American Rescue Plan. With these approvals, Nebraska and Mississippi become the 41 and 42 states, respectively, plus the District of Columbia and the U.S. Virgin Islands, which have extended postpartum Medicaid coverage. CMS has taken a holistic look at its policies and programs to identify opportunities to enhance maternity care delivered to the people CMS serves—specifically through a focus on driving improvements in access to and quality of care during pregnancy, childbirth, and the postpartum period. This effort is a central component of our work to advance health equity.
CMS Releases National Overview of State Spending to Enhance Home & Community-Based Services under Section 9817 of the American Rescue Plan
December 12: CMS released a national overview of state home and community-based services (HCBS) spending under the American Rescue Plan (ARP) section 9817. ARP section 9817 provided states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS beginning April 1, 2021, and ending March 31, 2022. HCBS delivers care to people in their homes and communities. States are expected to use state funds to match the increased FMAP and use it to add one or more activities that enhance, expand, or strengthen HCBS under the Medicaid program. CMS expects states to expend the funds by March 31, 2025. This is one example of the Biden-Harris Administration's historic nationwide investments in home and community-based care services and the care workforce.
CMS Releases 2023 Medicaid & CHIP Program Administration & Outcomes Scorecard
December 13: CMS released its 2023 Medicaid and Children's Health Insurance Program (CHIP) Scorecard. This scorecard was created to increase public transparency about the programs’ administration and health care outcomes. States and CMS can use the scorecard to drive improvements in areas such as state and federal alignment, beneficiary health outcomes, and program administration. The scorecard aligns with the Biden-Harris Administration’s commitment to making coverage better.
CMS Highlights Strides in Support of Executive Order on Transforming Federal Customer Service
December 13: CMS highlighted the two-year anniversary of the Executive Order on Transforming Federal Customer Experience. This year, CMS made great strides in support of this E.O. by expanding access to quality, affordable health coverage and care. CMS implemented changes to improve the experience with the “Getting Started” section of medicare.gov to address customer challenges for those just getting ready to sign up for Medicare. Improvements included streamlined navigation, plain language updates, and a new wizard explaining key deadlines and coverage options. As a result, customer satisfaction increased by 13% over the course of this year. CMS also streamlined the Medicare Savings Program (MSP) enrollment process by mandating that states utilize the information gathered through the Low-Income Subsidy (LIS) program both as an application and eligibility determination for MSPs. This change, finalized in September 2023, alleviates administrative burdens and makes enrolling eligible LIS recipients into MSPs easier. The agency also enabled automatic enrollment into the most comprehensive form of MSP coverage, the Qualified Medicare Beneficiary eligibility group, for certain people receiving supplemental security income (SSI), allowing them to gain important Medicare premium and cost-sharing assistance. All these actions help improve the customer experience and advance the Biden-Harris Administration’s commitment to millions of Americans who rely on Medicare.
Office of the Actuary Publishes 2022 National Health Expenditure Report & Data
December 14: The Office of the Actuary published the 2022 National Health Expenditures (NHE) historical estimates report. This report has been published annually since 1960 and is often referred to as the “official” estimates of U.S. health spending. The NHE measures total annual US spending for the delivery of health care goods and services by type of good or service (hospital, physician and clinics, prescription drugs, etc.), type of payer (private health insurance, Medicare, Medicaid, etc.) and type of sponsor (businesses, households, and federal/state governments). The NHE also includes spending on the net cost of insurance and government administration, government public health, investment in structures and equipment, and non-commercial research. Additional information and data can be found here and in this fact sheet.
CMS Sends Letter to Pharmacy Benefit Managers, Medicare Part D Plans, Medicaid Managed Care Plans, and Private Insurance Plans
December 14: CMS Administrator Chiquita Brooks-LaSure, Principal Deputy Administrator Jonathan Blum, and other members of CMS leadership sent a letter to pharmacy benefit managers, Medicare Part D plans, Medicaid managed care plans, and private insurance plans about an increasing number of concerns about certain practices by some plans and pharmacy benefit managers that threaten the sustainability of many pharmacies, impede access to care, and put increased burden on health care providers. CMS encouraged the plans and pharmacy benefit managers to work with providers and pharmacies to alleviate these issues and safeguard access to care.
Other Recent Releases:
December 1: 600,000 North Carolinians Now Have Access to Medicaid Expansion Coverage
December 14: CMS Releases Revised Guidance for Medicare Prescription Drug Inflation Rebate Program
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CMS, an agency within the U.S. Department of Health and Human Services, serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. The agency protects public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and the Health Insurance Marketplace.
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