CMS Round Up

CMS Roundup (Apr. 07, 2023)

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Today, the Centers for Medicare & Medicaid Services (CMS) is providing an at-a-glance summary of news from around the agency:

Increased Use of Telehealth & Medications for Opioid Use Disorder During the COVID-19 Pandemic Reduced Risk of Fatal Overdose

March 29: Collaborative research by CMS, the Centers for Disease Control and Prevention (CDC), and National Institute on Drug Abuse (NIDA) revealed that the expanded availability of opioid use disorder-related telehealth services and medications during the COVID-19 pandemic lowered the likelihood of fatal drug overdose among Medicare beneficiaries.

The findings were published in a joint CMS, CDC, and NIDA manuscript in JAMA Psychiatry.

Departments Issue FAQs on Coverage of COVID-19 Testing and Vaccines by Health Plans After the Public Health Emergency Ends

March 29: A set of frequently asked questions  (FAQs) were issued to help group health plans and health insurance issuers in the private market understand their obligations under the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act) related to coverage for COVID-19 diagnostic testing and vaccines following the expiration of the public health emergency. The FAQs were issued jointly by HHS, the Department of Labor, and the Department of Treasury.

CMS Approves Extension of New Jersey’s FamilyCare Section 1115 Demonstration

March 30: CMS approved New Jersey’s request to extend its FamilyCare Section 1115  Demonstration for five years, effective April 1, 2023, through June 30, 2028. The extension will ensure that people who are eligible for Medicaid based on their income receive 12 months of continuous eligibility. Under the demonstration extension, new programs have also been developed to assist in serving individuals and their health-related social needs, along with serving the community and advancing health equity by addressing health care gaps and improving access to care and overall better health outcomes. The approval letter can be viewed here

CMS Awards $5.9M in 2023 Connecting Kids to Coverage HEALTHY KIDS American Indian/Alaska Native Outreach and Enrollment Cooperative Agreements

March 30: To bolster efforts to increase enrollment of eligible uninsured American Indian/Alaska Native (AI/AN) children in Medicaid and the Children’s Health Insurance Program (CHIP), CMS awarded $5.9 million in funding for seven Connecting Kids to Coverage (CKC) HEALTHY KIDS American Indian/Alaska Native (AI/AN) 2023 Outreach and Enrollment Cooperative Agreements. Eligible applicants for this funding included Indian Health Service providers, Indian tribes, or Tribal entities. Information on the program and the list of grantees can be found here.

CMS Strengthens Enforcement Against Infection Control Deficiencies in Nursing Homes

March 30: As part of the President’s initiative to improve the safety and quality of care in the nation’s nursing homes, CMS has further strengthened its enhanced enforcement policy for infection control deficiencies (QSO-20-31-ALL) with revisions focusing on deficiencies that rise to severe and actual harm levels. This refocused enforcement will increase civil monetary penalties, shorten notice for discretionary denial of payment for new admissions, and require the directed plans of correction to include hiring an external infection control consultant or working with the Quality Improvement Organization.

Health Care Facilities May Now Use Clean Energy as an Alternate Power Source

March 31: CMS released and posted a memo detailing a new categorical waiver that is available to allow health care facilities to use clean energy power sources to meet backup power requirements. In addition to sustainability, these systems can be more reliable, efficient, redundant, and resilient as energy sources than the traditional fossil fuel-based generator systems still predominantly used by most facilities. The memo can be viewed here.

CMS Issues FAQs on Marketplace Health Plan Issuer Coverage of Abortion

March 31: CMS issued frequently asked questions reiterating that Qualified Health Plan (QHP) issuers offering coverage in the individual market through Marketplace Exchanges may still provide abortion coverage after the Dobbs v. Jackson Women’s Health Organization decision (when not prohibited by state law) and must comply with existing federal requirements pursuant to Section 1303 of the Affordable Care Act (ACA).

Arizona Extends Postpartum Coverage for Medicaid & CHIP

April 4: Arizona became the latest state to extend postpartum coverage for individuals enrolled in Medicaid and the Children’s Health Insurance Program, following CMS’ approval of the state’s postpartum coverage extension state plan amendments (SPAs). The opportunity to extend this coverage was made possible by the American Rescue Plan, and this approval marks 31 states and D.C. that have extended postpartum Medicaid/CHIP coverage to a full year. Click here and here to learn more about Arizona’s approvals in Medicaid and CHIP, respectively. 

CMS Responds to NEJM Catalyst Article on the State of Patient Safety

April 4: The New England Journal of Medicine’s Catalyst published a response by Dr. Lee Fleisher, CMS’ Chief Medical Officer to an article on patient safety and quality. The response outlines the current state of patient safety, and the toll taken by COVID-19 on the health care system’s efforts to bolster patient safety, and shares CMS’ perspective on how to support and drive the nation's health care system toward improved safety for patients. The article can be found here.


Medicare Advantage Value-Based Design Model Extension Builds on Success

April 5: CMS announced policy details regarding the extension of the Medicare Advantage Value-Based Insurance Design (VBID) Model through 2025-2030. The model tests innovations within Medicare Advantage intended to improve health care quality, reduce Medicare spending, and advance health equity. The model extension and changes build on the model’s successes to date and encourage an even greater focus on addressing health-related social needs. The details can be found here.

CMS Administrator Brooks-LaSure Covers the Medicare Basics in SSA Guest Blog

April 6: CMS Administrator Chiquita Brooks-LaSure covers the basics of Medicare coverage - outlining when and how to apply for Medicare, options to consider, and the tools available to help make Medicare coverage decisions - in a guest blog on Social Security Matters. This consumer-friendly read helps explain the Medicare program and underscores the importance of reviewing Medicare options to help consumers find the one that best meets their individual health care needs. This is the first part of a two-part blog series on Medicare basics.

CMS Announces Fiscal Year 2024 Proposed Payment Rules for Providers and Services

CMS issued Medicare fiscal year (FY) 2024 proposed payment rules for the following providers and services:  Skilled Nursing Facilities (SNFs), Hospice, Inpatient Rehabilitation Facilities (IRFs) and Inpatient Psychiatric Facilities (IPFs). In addition to details of the proposed rule, each fact sheet contains a link to where the proposed rule can be found on the Federal Register.

Medicare Drug Price Negotiation Comment Period Closing--Comments Due April 14

The deadline for public comments on the initial guidance for the Medicare Drug Pricing Negotiation program is closing, with comments due no later than April 14. Public feedback is critical to ensuring the Negotiation Program works for millions of people with Medicare, so comments are strongly encouraged and can be submitted to with the subject line “Medicare Drug Price Negotiation Program Guidance.” CMS will issue revised guidance this summer. More information can be found here.

Other Recent Releases

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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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