CMS Round Up

CMS Roundup (Nov. 17, 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 Research Letter Reports on Learnings from the Acute Hospital Care at Home Waiver 

November 3: The Journal of the American Medical Association (JAMA) Health Forum published a CMS research letter, titled "Initial Findings from an Acute Hospital Care at Home Waiver Initiative." The initiative enables some patients in need of acute-level care to receive care in their homes, rather than in a hospital. The research letter reports on key steps CMS employed to ensure patient safety for those receiving care in the home setting during the initial 16 months. 

CMS Approves New Hampshire’s and Missouri’s Expansion of Postpartum Coverage for a Full Year to People with Medicaid

November 3: CMS approved a state plan amendment for New Hampshire to extend postpartum coverage to a full year for individuals enrolled in Medicaid. 

November 14: CMS approved a state plan amendment for Missouri to extend postpartum coverage to a full year for individuals enrolled in Medicaid. This approval marks 40 states, the District of Columbia, and the U.S. Virgin Islands that have extended postpartum Medicaid coverage to a full year. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Postpartum coverage extensions form one of the cornerstones of CMS’ Maternal Care Action Plan — part of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. 

Medicare Care Choices Model Improved Quality of Life and Care for Medicare Hospice Enrollees While Reducing Costs and Acute Care Service Use 

November 6: CMS released the final annual report evaluating the Medicare Care Choices Model, which was created to provide people with Medicare, and their caregivers and providers, with greater flexibility when facing a life-limiting illness. The model tested a new option for Medicare beneficiaries to receive supported care services from selected hospice providers, while continuing to receive services provided by other Medicare providers, including care for their terminal condition. Under current payment rules, Medicare does not pay for care related to a person’s terminal condition after that person elects the Medicare hospice benefit. The key takeaways are that, by providing high-quality supportive services and expanding the use of Medicare’s hospice benefit, participating hospices improved enrollees’ quality of life and care, attained high satisfaction, and reduced Medicare expenditures and acute care service use.  

CMS Releases No Surprises Act Consumer Toolkit to Aid Advocates with Outreach Efforts

November 8: CMS released a new toolkit to support advocates helping consumers understand new rights and protections under the No Surprises Act,. Signed into law on December 27, 2020, the No Surprises Act gives consumers new federal protections from surprise medical bills. The toolkit includes a variety of resources, such as fact sheets, decision-support tools, and sample documents to aid advocates in their outreach efforts. 

CMS Approves Oregon’s Extension for Family Planning Services Demonstration for People with Medicaid

November 8: CMS approved Oregon’s request for a five-year extension of its Medicaid section 1115 demonstration, “Oregon Contraceptive Care,”  which authorizes the state to provide family planning services for individuals eligible under this demonstration. CMS is also authorizing continuous eligibility for those enrolled to align this demonstration with the Oregon Health Plan demonstration to support consistent coverage and continuity of care for 24 months, regardless of income fluctuations or other changes. In addition, that extension requires the state to provide non-emergency medical transport for the demonstration populations beginning January 1, 2025. 

CMS Updates Spousal Impoverishment Standards and Medicaid Savings Program Resource Levels

November 14: CMS released an informational bulletin updating the Spousal Impoverishment Standards and Medicare Savings Program (MSP) resource levels for Medicaid. Under the Medicaid spousal impoverishment provisions, a certain amount of a couple's combined resources is protected for the spouse living in the community. Depending on how much of their  own income the community spouse has, a certain amount of income belonging to the spouse in the institution can also be set aside for the community spouse's use. The MSP is a Medicaid-administered program that can assist people with limited income pay for their Medicare premiums and underscores CMS’ commitment to advancing health equity in the program.

CMS Opens Request for Applications for the Guiding an Improved Dementia Experience Model

November 15: CMS announced a Request for Applications for the Guiding an Improved Dementia Experience (GUIDE) Model. All applications must be submitted through the online application portal by 11:59 p.m. Eastern time on January 30, 2024. The model aims to improve the quality of life for people living with dementia, reduce strain on caregivers, and help people remain in their homes and communities through care coordination and management, caregiver education, and clinical support and respite services. The GUIDE model is a key deliverable from President Biden’s April 2023 Executive Order on Increasing Access to High Quality Care and Supporting Caregivers and aligns with key goals of the National Plan to Address Alzheimer's Disease.

CMS Posts Notice of Marketplace Benefit and Payment Parameters for 2025 Proposed Rule 

November 15: CMS published the Patient Protection and Affordable Care Act, Health & Human Services Notice of Benefit and Payment Parameters for 2025 Proposed Rule (CMS-9895-P). The rule proposes standards for issuers and Marketplaces, and requirements for agents, brokers, web brokers, and assisters who help consumers with enrollment through the federal Marketplace platform. Additional information can be found in this fact sheet. The proposals build on the Affordable Care Act’s promise to expand access to quality, affordable health coverage by increasing access to health care services, simplifying choice and improving the plan selection process, making it easier to enroll in coverage, and strengthening markets.

CMS Releases Improper Payment Data & Corrective Actions in FY 2023 Financial Report 

November 15: CMS released improper payment data and corrective actions in the agency Fiscal Year 2023 Financial Report associated with the payment of the Advance Premium Tax Credit, Medicare Fee-for-Service (FFS), Part C (Medicare Advantage), Part D (prescription drugs) and Medicaid/Children's Health Insurance Program (CHIP) programs. Improper payments can be overpayments or underpayments or payments where insufficient information was provided to determine whether a payment was proper. Most involve situations where a state or provider missed an administrative step. The vast majority are not fraud, and improper payment estimates are not fraud estimates. Additional information can be found in the fact sheet. This data aligns with the Biden-Harris Administration’s goal of maintaining the long-term sustainability of CMS’ programs. 

CMS Awards Round Two of New Medicare-Funded Graduate Medical Education Residency Slots 

November 15: CMS announced 200 new graduate medical education (GME) residency slots awarded to 99 qualifying hospitals to enhance the health care workforce and fund additional positions in hospitals serving underserved communities under section 126 of the Consolidated Appropriations Act (CAA), 2021. This is the second round of the 1,000 new Medicare-funded medical residency positions authorized under this law, which are phased in at no more than 200 slots per year beginning in FY 2023. The law requires that the second round of residency slots become effective July 1, 2024. This is a critical step to advance health equity and underscores CMS’ commitment to address access to care challenges and workforce shortages in the highest need areas to provide high-quality care to all people.  

CMS Releases Details on All Medicaid and CHIP Health-Related Social Needs Expenditures

November 16: CMS released an informational bulletin for Medicaid and the Children's Health Insurance Program detailing health-related social needs (HRSNs) expenditures, such as housing instability or food insecurity. Accompanying the informational bulletin is a table summarizing all HRSN expenditure authorities CMS has historically approved via Medicaid section 1115 demonstrations, state plan amendments, and 1915 waivers. This information demonstrates CMS’ commitment to addressing social determinants of health and the impact they have on the individuals, families, and children who rely on Medicaid and CHIP.

CMS Releases Notice of Funding Opportunity Applications for AHEAD Model

November 16: CMS released the Notice of Funding Opportunity for the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. There will be two application periods where states can apply, the first closing on March 18, 2024, and the second application closing on August 12, 2024. CMS’ goal in the AHEAD Model is to collaborate with states to curb health care cost growth, improve population health, and advance health equity by reducing disparities in health outcomes. Through AHEAD, CMS aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources, like housing and transportation, to address social drivers of health. The AHEAD model is a critical step towards addressing disparities in both health care and health equity while improving overall population health.

Other Recent Releases: 

November 6: Biden-Harris Administration Proposes to Protect People with Medicare Advantage and Prescription Drug Coverage from Predatory Marketing, Promote Healthy Competition, and Increase Access to Behavioral Health Care in the Medicare Advantage Program

November 8: Biden-Harris Administration Launches "Birthing-Friendly" Designation on Web-Based Care-Compare Tool

November 14:With Missouri Approval, 40 States Now Offer Full Year of Medicaid Coverage After Pregnancy

November 15: Biden-Harris Administration Continues Unprecedented Efforts to Increase Transparency of Nursing Home Ownership


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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