CMS Round Up
CMS Roundup (May. 19, 2023)
Today, the Centers for Medicare & Medicaid Services (CMS) is providing an at-a-glance summary of news from around the agency:
CMS Continues to Provide Timely Updates to Providers, Partners, and the Public Related to the End of the COVID-19 Public Health Emergency (PHE)
May 8: CMS confirmed certain Medicaid, Children’s Health Insurance Program Services (CHIP), and Basic Health Program authorities sunset after the COVID-19 Public Health Emergency (PHE) ends on May 11 in an information bulletin to states. The bulletin noted that telehealth flexibilities for Medicaid and CHIP are not tied to the PHE. Those flexibilities were available prior to and continue now that the PHE has ended. The bulletin also included key expiration dates for certain flexibilities and requirements (some are after May 11). CMS urged states to review their policies, systems, and procedures to ensure compliance with changes, while also keeping providers and enrollees informed of any changes.
May 8: CMS issued updated Nursing Home Visitation-COVID-19 guidance to state survey agencies. The update aligns with the end of the COVID-19 Public Health Emergency (PHE) and the Centers for Disease Control and Prevention (CDC) guidance. The guidance notes visitation is allowed for all residents at all times and facility policies regarding face coverings and masks should be based on recommendations from the CDC, state and local health departments, and individual facility circumstances. CMS continues to strongly encourage visitors to stay up to date with their COVID-19 vaccinations for the health and safety of nursing home residents.
May 11: CMS released updated Clinical Laboratory Improvement Amendment (CLIA)
guidance that notes the federal requirement for laboratories to report SARS-CoV-2 test results expired with the end of the COVID-19 Public Health Emergency (PHE) on May 11. CMS cautioned there may be additional state reporting requirements that are not enforced by CMS. Laboratories are urged to verify all current guidance before discontinuing reporting of test results.
May 12: CMS posted frequently asked questions to support state unwinding efforts and provide additional guidance to states. The FAQ covers the end of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act. The FAQ’s cover a range of topics from temporary reporting requirements to enforcement provisions. CMS will provide period updates and provide additional guidance to states. Resources and tools supporting state unwinding efforts can be found here.
May 12: CMS posted updated frequently asked questions (FAQs) on how the end of the COVID-19 Public Health Emergency (PHE) will impact various waivers and flexibilities that were implemented to address the pandemic. This is part of CMS’ ongoing efforts to prepare providers, partners, and the public for the end of the PHE. CMS will continue to provide periodic updates, as needed, as the public and other interested parties raise new questions.
May 17: CMS updated Coverage to Care (C2C) resources to reflect the end of the COVID-19 Public Health Emergency (PHE) and help consumers better understand their health care coverage and get the services they need. Updated resources include the Roadmap to Better Care, Roadmap to Behavioral Health, Prevention Flyers and more. These updated materials are available in both English and Spanish. Additional languages will be made available soon. Information is available here.
Medicare Home Health Value-Based Purchasing Model Shows Improved Quality of Care & Reduced Spending
May 8: CMS released the sixth annual evaluation report on the Home Health Value-Based Purchasing (HHVBP) model, which showed improvement in care quality and reduced Medicare expenditures. The HHVBP model established financial incentives for higher quality care and greater efficiency through adjustments to Medicare payments for home health services. Total performance scores for home health agencies increased by 6% in year six. Among home health users in HHVBP states, Medicare spending decreased $2.63 per day, or 1.9% for the home health episode plus the 30 days following, resulting in cumulative savings of $1.3 billion.
The CMS Innovation Center Outlines Progress Made in Health Equity Strategy
May 11: The CMS Innovation Center outlined the progress in its health equity strategy in a blog post on Health Affairs. The Innovation Center has taken a number of meaningful actions that will help mitigate health inequities within the populations served by CMS' programs. The blog provides a one-year look back at accomplishments and describes additional focus areas. The blog can be found at https://www.healthaffairs.org/content/forefront/advancing-health-equity-through-cms-innovation-center-first-year-progress-and-s-come
CMS Approves Mobile Crisis Intervention Services for Wisconsin Medicaid Program
May 12: CMS approved a Mobile Crisis State Plan Amendment for Wisconsin. Authorized under President Biden’s American Rescue Plan, states have a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid. Mobile crisis intervention services are essential tools to meet people where they are and rapidly provide 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.
Hospice Surveys, Statements of Deficiencies, Now Publicly Available on CMS.gov
May 12: Hospice program surveys and statements of deficiencies are now available on CMS.gov. The Consolidated Appropriations Act, 2021 requires public reporting conducted by both state agencies (SAs) and Accrediting Organizations (AOs), as well as enforcement actions taken as a result of these surveys, prominently on the CMS website in a manner that is easily accessible, searchable, and presented in a readily understandable format. This is one of many efforts to increase transparency and accountability in health care. The surveys and deficiency reports can be found here.
CMS Approves Delaware Postpartum Coverage Expansion Under the American Rescue Plan
May 15: CMS marked another important maternal health milestone by approving Medicaid and Children’s Health Insurance Program (CHIP) postpartum coverage expansion in Delaware, an opportunity made possible through the American Rescue Plan. This approval marks 33 states and the District of Columbia that have extended postpartum Medicaid/CHIP coverage to a full year. Information about Delaware’s postpartum coverage extension for Medicaid can be found here; Delaware’s postpartum coverage extension for CHIP can be found here.
CMS Updates Strategic Plan, Includes Expanding Access to Oral Health, Outlines Advances in Health Equity and Promoting Alignment to Ensure Seamless Care Across Programs
May 16: CMS updated its Strategic Plan to include a new Cross Cutting Initiative (CCI): Oral Health. Through this CCI, CMS will implement policy changes and consider opportunities through existing authorities to expand access to oral health coverage. CMS is also advancing Health Equity and released a fact sheet detailing agency actions to date on this key pillar. Finally, CMS added a new fact sheet on Integrating the 3Ms (Medicare, Medicaid and Marketplace) CCI. The fact sheet outlines how CMS has developed approaches to promote alignment and consistency across programs, promoting seamless continuity of care, including experiences with health care providers and health coverage for people served by the 3Ms.
CMS Announces Funding Opportunity for Researchers Investigating Health Care Disparities
May 16: As part of its commitment to ending health disparities, CMS’ Minority Research Grant Program (MRGP) released a Notice of Funding Opportunity for researchers at minority-serving institutions (MSIs) who are investigating or addressing health care disparities affecting CMS focus populations. Focus populations include racial and ethnic minority groups; members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community; people with disabilities; individuals with limited English proficiency; people who live in rural areas; and people otherwise adversely affected by persistent poverty or inequality. CMS will award up to three grants, totaling up to $333,000 each.
CMS Temporarily Extends Section 1115 Demonstration: Idaho Behavioral Health Transformation
May 16: CMS temporarily extended the “Idaho Behavioral Health Transformation” section 1115 demonstration, allowing the state to pay legally responsible individuals, such as spouses or parents, to provide personal care services (PCS) to program participants through November 11, 2023. Since March 1, 2020, Idaho Medicaid has allowed personal assistance agencies (PAAs) contracted with the state to temporarily employ spouses of adult participants and parents of minor children receiving PCS. This latest approval allows the state to extend this flexibility beyond the end of the PHE to allow PAAs sufficient time to assist families with identifying other caregivers for their spouse or child. Information is available here.
Power Seat Elevation Equipment for Power Wheelchairs Now Eligible for Medicare Coverage
May 16: CMS issued a national coverage decision establishing power seat elevation equipment for power wheelchairs as durable medical equipment eligible for coverage by Medicare. People with Medicare who perform transfers from power wheelchairs, or reach from their chair for mobility-related activities of daily living, such as dressing, grooming, toileting, feeding and bathing, can receive Medicare-covered seat elevation equipment effective immediately. This decision is expected to directly impact the quality of life for thousands of beneficiaries.
CMS Releases Accountable Health Communities Model Second Evaluation Report
May 17: CMS released the second evaluation report for the CMS Innovation Center’s Accountable Health Communities (AHC) model. The model was intended to test whether identifying and addressing health-related social needs (HRSNs) of people with Medicare or Medicaid through screening and community navigation services reduces health care costs and utilization. Among the key take-aways are that navigation services alone did not result in better access to community services or resolving HRSNs; however, navigation still may be influencing beneficiary behavior, resulting in reduced emergency department visits.
CMS Approves New Mexico and Oregon Proposals to Expand Access to Care for Kids in Schools
May 18: CMS approved state plan amendments (SPAs) for the states of New Mexico and Oregon. Through these SPAs, the states have the option to provide physical and behavioral health services to any students — versus only those with an Individualized Education Program (IEP) enrolled in Medicaid — and get federal Medicaid reimbursement for those services. The New Mexico SPA details can be found here and the Oregon SPA details can be found here.
Other Recent Releases
Biden-Harris Administration Takes Action to Help Schools Deliver Critical Health Care Services to Millions
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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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