CMS Round Up
CMS Roundup (June 30, 2023)
Today, the Centers for Medicare & Medicaid Services (CMS) is providing an at-a-glance summary of news from around the agency.
IRA Extends Insulin Cost Caps to Medicare Part B and Medicare Advantage Starting July 1
Starting July 1, people with Medicare Part B and Medicare Advantage coverage who get their insulin through a traditional pump will see insulin costs capped at $35 per month per each covered insulin. Millions of people with Medicare Part D are already benefiting from the Inflation Reduction Act’s $35 monthly cap, and if these rules for Part B and Part D had been in effect in 2020, 1.5 million beneficiaries would have saved an average of $500 per year. CMS created a series of resources, including an FAQ, social media toolkit, and more, to help ensure people can benefit from these important provisions.
CMS Proposes New Pathway for Transitional Coverage for Emerging Technologies
June 22: CMS announced a new proposed Transitional Coverage for Emerging Technologies (TCET) pathway to promote faster and more consistent access to certain FDA-approved breakthrough technologies for people with Medicare. The proposal also calls for data collection that could be used to help clinicians and patients make better-informed treatment decisions. CMS is seeking public comment until 5 p.m. on August 28, 2023, via the Federal Register. CMS will respond to public comments in a subsequent final notice. Details and additional information can be found in this fact sheet and blog posted on CMS.gov.
CMS Announces New Details of Plan to Cover New Alzheimer’s Drugs
June 22: CMS released new details about how people can get drugs that may slow the progression of Alzheimer’s disease covered by Medicare. Specifically, Medicare will cover Alzheimer’s drugs that receive traditional Food and Drug Administration (FDA) approval when a physician and clinician team participates in an effort to collect real-world information that will help to study the usefulness of these drugs for people with Medicare. A CMS-facilitated data submission platform that clinicians can use for this purpose will be ready in the event the FDA grants traditional approval to one of these drugs. This approach is consistent with the National Coverage Determination (NCD) CMS issued on April 7, 2022.
U.S. Virgin Islands to Extend Medicaid Postpartum Coverage for Full Year
June 23: The U.S. Virgin Islands (USVI) received approval to extend postpartum coverage for a full year after pregnancy for individuals enrolled in Medicaid. CMS' approval of the USVI state plan amendment that allows this US territory to extend postpartum coverage to protect the health of mothers and babies was made possible by the American Rescue Plan.
CMS Launches School-Based Services Technical Assistance Center
June 23: CMS is working with the Department of Education to help states bring health care to kids at schools to maximize Medicaid coverage and grow connections to care. As promised in the May 23 release of the School-Based Services (SBS) Comprehensive Guide to Medicaid Services and Administrative Claiming , CMS launched the SBS Technical Assistance Center (TAC). The TAC will aid Medicaid agencies, local education agencies (LEAs), and school-based entities in their efforts to deliver expanded Medicaid services to students. TAC will convene small group stakeholder calls with target audience members, emphasizing schools located in small rural communities and offering resource materials tailored to the specific needs of the LEAs in their communities.
CMS Issues ESRD Proposed Payment Rule for Calendar Year (CY) 2024
June 26: CMS issued a proposed rule that updates payment Medicare rates under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to people with Medicare beginning on January 1, 2024. For 2024, CMS proposes increasing ESRD PPS total payments to ESRD facilities by approximately 1.6 percent compared to 2023. This rule also proposes updates to the Acute Kidney Injury dialysis payment rate for renal dialysis services furnished by ESRD facilities; a payment change for pediatric ESRD patients; payment changes to support access to certain new renal dialysis drugs and biological products; reporting requirements for dialysis duration, and for discarded amounts of certain renal dialysis drugs and biological products; and updated requirements for the ESRD Quality Incentive Program. Details are available in the fact sheet. The proposed rule will be published in the Federal Register on June 30, with comments due by August 25, 2023.
CMS Offers Guidance on New Mandatory Coverage of Vaccines for Adults Under the Inflation Reduction Act
June 27: CMS provided guidance to states on implementing new mandatory vaccine coverage for adults to reduce hospitalizations, deaths, and morbidity. The Inflation Reduction Act (IRA) mandates Medicaid and CHIP coverage of Food and Drug Administration approved adult vaccines recommended by the Advisory Committee on Immunization Practices and their administration, without cost-sharing beginning October 1, 2023. This coverage applies to nearly all full-benefit people covered under traditional Medicaid and CHIP beneficiaries aged 19 and older. The CMS letter to states can be viewed here. Additional details can be found on this fact sheet.
CMS Innovation Center Announces Participants in the Enhancing Oncology Model
June 27: The CMS Innovation Center announced the organizations participating in the Enhancing Oncology Model (EOM). Launching on July 1, 2023, the five-year model test is aligned with the Biden-Harris Administration’s Cancer Moonshot priorities to support patients, caregivers, and survivors and address inequities. As of June 27, 2023, EOM consists of 67 oncology physician group practices (PGPs) and two commercial payers. Across the 67 group practices, there are over 600 sites of care representing approximately 37 states and over 3,000 unique practitioners. Details can be found on this fact sheet; additional information on the model, including a link to the participant’s list, can be found here.
CMS Approves Maryland’s 1332 Waiver Extension Request
June 28: CMS approved Maryland's 1332 Waiver extension request to continue implementing its state-based reinsurance program for another five years. The waiver extension allows Maryland to continue to pursue innovative strategies for providing residents with access to high-quality, affordable, health insurance while retaining the basic protections of the Affordable Care Act (ACA). Maryland’s waiver extension provides a continued implementation of its state-based reinsurance program, called the Maryland State Reinsurance Program (SRP), for plan years 2024 through 2028.
CMS Increases Nursing Home Transparency with Ownership/Affiliation Data, Plus Entity Safety, Staffing & Quality Metrics
June 28: As part of the Biden-Harris Administrations’ ongoing initiative to increase the transparency of corporate ownership in the nation’s nursing homes, CMS posted additional nursing home ownership and operator affiliation data on Nursing Home Compare. CMS also released the Nursing Home Affiliated Entity Performance Measures dataset on data.cms.gov, which aggregates safety, staffing, and quality performance metrics across affiliated entities. This information can also be used by states to gain more information about prospective owners and operators of nursing homes prior to certification of new nursing homes and during change of ownership requests.
CMS Announces Funding Opportunity for Minority Health Researchers
June 29: CMS announced a new funding opportunity for minority health researchers as part of the Health Equity Data Access Program (HEDAP). Through HEDAP, CMS will support up to three “seats” in the CMS Virtual Research Data Center (VRDC), with each individual grant worth up to $90,000. Selected researchers will gain access to CMS-restricted data to conduct health services research on racial and ethnic minority groups; people with disabilities; members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community; individuals with limited English proficiency; individuals residing in rural areas; and individuals adversely affected by persistent poverty or inequality. Researchers selected for the grant will receive funding for a period of thirty-six months. The notice of funding opportunity is here. The deadline to submit applications is August 15 at 3 p.m.
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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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