CMS Round Up

CMS Roundup (July 28, 2023)

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

CMS Approves California State Plan Amendment Simplifying Medicaid Eligibility Rules

July 14:  CMS approved a first of its kind state plan amendment to allow California to eliminate the traditional “asset test,” simplifying the state's Medicaid eligibility process. Details can be found here.

CMS Innovation Center Seeks Input on Next Episode-Based Payment Model

July 14: CMS is seeking input from the public regarding the design of a potential new episode-based payment model. The goal of the model would include improving beneficiary care and lowering Medicare expenditures by reducing fragmentation and increasing care coordination across health care settings. Click here for more information. Comments must be submitted by August 17, 2023. 

CMS Highlights Important Changes to Improve Access to Behavioral Health

July 14: CMS published a blog highlighting essential changes to improve access to behavioral health in Medicare as we emerge from the COVID-19 public health emergency through proposals in the Calendar Year 2024 Physician Fee Schedule and Outpatient Prospective Payment System Proposed Rules. The blog discusses CMS’ proposals to expand the behavioral health workforce, cover gaps in access to behavior health services, and pay more accurately for services.

CMS Releases First Annual Evaluation Report for the End-Stage Renal Disease Treatment Choices Model

July 17: CMS released the first annual evaluation report for the End-Stage Renal Disease (ESRD) Treatment Choices Model. The model aims to encourage greater use of home dialysis and kidney transplants for people on Medicare with ESRD, while reducing Medicare expenditures and preserving or enhancing the quality of care. The report can be found here, and here is an at-a-glance summary.

CMS Proposes Medicare National Coverage Determination for Alzheimer PET Scans

July 17:  CMS proposed expanded patient access and coverage to include Alzheimer scans for people with Medicare in a National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease. This action underscores CMS‘ commitment to helping people with Alzheimer’s disease have timely access to innovative treatments. The public has an opportunity to comment on the proposal and details can be found here.

CMS Released New Materials and Updates on the Inflation Reduction Act

July 18: CMS continues to implement the Inflation Reduction Act to lower health care costs for consumers. CMS released a summary with sample calculations of how monthly costs may be calculated under the provision of the new drug law requiring Part D sponsors to provide enrollees the option to pay out-of-pocket prescription drug costs in monthly payments over the course of the plan year, instead of upfront, beginning in 2025, and a new FAQ for Medicare Advantage plans clarifying how certain provisions apply.   CMS also released a Revised Information Collection Request seeking  comments on the negotiation process for the Medicare Drug Pricing Negotiation Program.

CMS Details Efforts & Information to Assist States in Medicaid and CHIP Redetermination Process

July 18: CMS posted a fact sheet updating the agency’s efforts to assist states as they continue renewing eligibility for all Medicaid and CHIP enrollees following the end of the continuous enrollment condition on March 31, 2023, under the Consolidated Appropriations Act, 2023.  In addition, CMS released a table addressing mitigation strategies related to Medicaid and CHIP eligibility renewals. This action is part of CMS’ ongoing efforts to ensure States have the information they need to help people maintain health care coverage.

CMS Released Third Evaluation Report of the Vermont All-Payer Accountable Care Organization (ACO) Model

July 20: CMS released the third evaluation report of the Vermont All-Payer Accountable Care Organization Model. This model tests whether scaling an ACO model across all major payers in the state will facilitate broad care delivery transformations, reduce statewide spending, and improve health outcomes for people. The report can be found  here, and here is an at-a-glance summary.

CMS Imposed Civil Monetary Penalties on Three Hospitals Not in Compliance with Hospital Price Transparency Rule

July 25: CMS notified three hospitals it is imposing civil monetary penalties for not complying with the requirements of the Hospital Price Transparency final rule. In accordance with the regulation, the notices are posted here. This action underscores CMS’ commitment to ensuring hospitals provide consumers and stakeholders with required information on hospital charges.

CMS Posts Action Plan for Mental Health and Substance Abuse Disorder Treatment & Services for Medicaid and CHIP

July 25: CMS released the Medicaid and CHIP Mental Health (MH) and Substance Use Disorder (SUD) Action Plan Overview and Guide, which outlines the agency’s strategies for improving treatment and support for enrollees with these conditions. Areas of focus include improving coverage and integration to increase access to prevention and treatment services, encouraging engagement in care through increased availability of home and community-based services and coverage of non-traditional services and settings, and improving quality of care for MH conditions and SUDs. Additionally, the  Behavioral Health Cross Cutting Fact Sheet was updated to include recent CMS accomplishments and proposals. 

 CMS Blog Highlights Findings from the Medicaid & CHIP Health Equity Data Briefs

July 25: CMS published a blog highlighting findings from the recently released Medicaid health equity data briefs. The briefs detailed characteristics of enrollees in Medicaid and the Children’s Health Insurance Program. The four briefs focused on race and ethnicity, rural data, language data, and enrollees who qualify for Medicaid based on disability. In addition to the blog, the briefs can be found on this site.

CMS Updates Overall Hospital Quality Star Ratings, VA Hospitals Included for the First Time

July 26: CMS updated the Overall Hospital Quality Star Ratings on its Care Compare website,  which for the first time will include Veterans Health Administration (VA) hospitals. Updated yearly, the Overall Star Rating summarizes data from existing measures on Care Compare for each hospital to allow patients and caregivers to compare hospitals easily. The CMS Care Compare website provides consumers with information on more than 100 quality measures. Information about the Overall Hospital Quality Star Ratings data release can be found here.

CMS Finalizes Fiscal Year 2024 Medicare Payment Policies

July 27: CMS issued the Fiscal Year 2024 Inpatient Rehabilitation Facilities (IRF) Prospective Payment System (PPS) final rule (CMS-1781-F). This rule updates Medicare payment policies and rates under the IRF PPS and IRF Quality Reporting Program for 2024. Details are in the fact sheet.

July 27: CMS issued the Fiscal Year 2024 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Quality Reporting Updates final rule (CMS-1783-F). This rule updates Medicare payment policies and rates under the IPF PPS and IPF Quality Reporting Program for 2024. Details are in the fact sheet.

Other Recent Releases:

July 20: CMS Approves California & Kentucky Requests to Provide Essential Behavioral Health Services Through Mobile Crisis Intervention Teams

July 25: Departments of Labor, Health and Human Services and Treasury Announce Proposed Rules to Strengthen Mental Health Parity & Addiction Equity Act


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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