CMS Round Up

CMS Roundup (Feb. 10, 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:

CMS Releases Updated Resources to Prepare for theMay 11 End of the COVID-19 Public Health Emergency and National Emergency

January 30: The Biden Administration announced its intent to end the COVID-19 national emergency and public health emergency declarations on May 11, 2023. To ensure a smooth transition and help protect the health and well-being of the American people, CMS has taken immediate action to update fact sheets and other supporting resources to prepare for changes that will occur beginning on May 11.

CMS Acts to Help Individuals and Families Maintain Medicaid Coverage or Successfully Transition to the Health Insurance Marketplaces

January 27: In preparation for helping states/territories redetermine tens of millions of enrollees’ eligibility for Medicaid and CHIP following the March 31, 2023 end to the Medicaid continuous enrollment condition, CMS issued a state health official letter outlining new requirements for states in the Consolidated Appropriations Act, 2023 (CAA, 2023). This process  will be the single largest health coverage transition since the first open enrollment period of the Affordable Care Act. CMS is using every tool to ensure all eligible individuals can maintain their Medicaid or CHIP coverage, or transition to other affordable coverage, such as the Health Insurance Marketplaces. As part of these efforts, CMS developed a toolkit with important information for people with Medicaid or CHIP about steps they need to take to renew their coverage through those programs.

January 27: Many individuals and families who are no longer eligible for Medicaid or CHIP will be able to transition to other coverage options, including health insurance plans available from the Health Insurance Marketplaces. To help these consumers successfully transition, CMS has outlined Special Enrollment Period flexibilities for qualified individuals and their families who lose Medicaid or CHIP coverage following the unwinding of the Medicaid continuous enrollment condition.

CMS Announces New Resources for States to Strengthen Home and Community-Based Direct Service Workforce

January 27: CMS shared tools and best practices related to the home- and community-based services (HCBS) direct service workforce (DSW) as part of its commitment to strengthening the health care workforce. Direct service workers provide essential supports to older adults and people with intellectual and developmental disabilities, physical disabilities, and behavioral health needs. As part of the ongoing effort to support this workforce, CMS released an online training course and a series of resources that offer strategies and information on self-direction of home and community-based services, strengthening the DSW in rural areas, and emerging strategies for states. The online training also provides guidance and helpful information on finding, hiring, and retraining direct service workers.

CMS Leverages Data to Combat Over-Prescribing of Opioids by Medicare Part D Prescribers

January 30: CMS is committed to combating the opioid crisis and routinely gives Medicare providers information and reliable resources to prescribe opioids safely and appropriately. As part of that data-driven effort to ensure patients receive the best possible care, CMS sent letters to 247 Medicare Part D prescribers who are in the highest 10th percentile of prescribers in their specialty and state. The letters included personalized information about their prescribing practices and highlighted trusted opioid prescribing resources available to them.

CMS Enrollment Data for Medicare, Medicaid and CHIP Now Includes Enrollment in Part D Low-Income Subsidy Program

January 31: CMS published Medicare enrollee counts by state/territory and county for calendar years 2017–2021 and the latest 12 months (November 2021 to October 2022). This data is used to help track enrollment trends and, for the first time, now includes the number of people with Medicare Part D prescription drug coverage receiving the full or partial low-income subsidy. CMS also released the October 2022 Medicaid and CHIP Enrollment Report and Trend Snapshot, which shows 91,342,256 individuals were enrolled in Medicaid and CHIP in the 50 states and the District of Columbia that reported enrollment data.

CMS Outlines Approach to Establishing a Universal Foundation of Quality Metrics

February 1: The New England Journal of Medicine (NEJM) published a CMS perspective piece  on the importance of establishing a universal foundation of quality metrics. Currently, CMS operates more than 20 quality programs focused on individual clinicians, certain health care settings, health insurers, and value-based entities, such as accountable care organizations. Each of these programs has its own set of quality measures. The article outlines the agency’s approach to aligning quality measures across all CMS programs and the entire care continuum to promote the best, safest, and most equitable care for all individuals. These efforts are part of the CMS National Quality Strategy and Medicare Value-Based Care Strategy.

CMS Advises Prescribers & Medigap Plans on Beneficiary Cost-Sharing for Part B Rebatable Drugs Under the Inflation Reduction Act (IRA)

February 9: Effective January 1, 2023, the Inflation Reduction Act of 2022 requires drug companies that raise their prices for certain Medicare Part B drugs faster than the rate of inflation to pay Medicare back for the difference. On February 9, CMS sent educational material to prescribers and Medigap plans advising that, beginning April 1, 2023, beneficiary coinsurance for certain Part B drugs (including biological products) with prices that increase at a rate faster than inflation will be adjusted so that coinsurance for people with Medicare reflects the lower inflation-adjusted payment amount. This new inflation rebate applies to certain Medicare Part B single source drugs and biological products. CMS will post the April drug pricing files in March.

CMS Addresses Inequities in Rural Health in Medicare

February 10: CMS posted a blog on addressing rural health inequities in Medicare, a cornerstone of CMS’ effort to improve health equity. Compared to urban Americans, rural Americans are more likely to have heart disease, stroke, cancer, unintentional injuries, suicide risk, and chronic lung disease. The authors advance a three-pronged approach of supporting rural providers, making rural health care more effective, and transforming the rural health delivery system to improve access to high-quality, coordinated care in rural areas.

Other Recent Releases

January 30: Biden-Harris Administration Proposes New Rules Expanding Access to Birth Control Coverage Under the ACA

January 30: CMS Issues Final Rule to Protect Medicare, Strengthen Medicare Advantage and Hold Insurers Accountable

February 1: CMS Releases 2024 Advance Notice Proposed Payment Updates to Medicare Advantage and Part D Plans

February 9: HHS Releases Initial Guidance on 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 the public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and health insurance portability standards.

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