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Thursday, July 6, 2023


MLN Matters® Articles


From Our Federal Partners



CY 2024 Home Health Prospective Payment System Proposed Rule

CMS issued the CY 2024 Home Health (HH) Prospective Payment System Rate Update proposed rule, which would update Medicare payment policies and rates for Home Health Agencies (HHAs). This rule proposes a permanent, prospective adjustment to the CY 2024 HH payment rate to account for the impact of the implementation of the Patient-Driven Groupings Model.

This rule proposes routine, statutorily required updates to the HH payment rates for CY 2024. We estimate that Medicare payments to HHAs in CY 2024 would decrease in the aggregate by 2.2%, or $375 million compared to CY 2023, based on the proposed policies.

See the full fact sheet.


HHS Announces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices

Starting this year, Medicare will begin to negotiate directly with drug manufacturers to bring down the price of covered high-cost prescription drugs. CMS will announce the first 10 drugs selected for negotiation by September 1, 2023. The first round of negotiations will occur during 2023 and 2024. The prices that are negotiated will be effective starting in 2026.

CMS released revised program guidance, informed by public input, that outlines how CMS will negotiate to reach agreement on a maximum fair price for a selected drug with participating manufacturers, ensuring that Medicare beneficiaries have access to innovative, life-saving treatments at costs that will be lower for both them and Medicare.

HHS also announced that President Biden’s cap on insulin costs at $35 per month went into effect for people who get their insulin through Medicare Part B and Medicare Advantage with use of a traditional pump starting July 1, 2023.

More Information:


CMS Roundup (June 30, 2023)

You may be interested in these topics from the CMS Roundup:

  • CMS Offers Guidance on New Mandatory Coverage of Vaccines for Adults Under the Inflation Reduction Act
  • CMS Increases Nursing Home Transparency with Ownership/Affiliation Data, Plus Entity Safety, Staffing & Quality Metrics
  • CMS Announces Funding Opportunity for Minority Health Researchers


Skilled Nursing Facility: COVID-19 Enforcement Discretion for Pharmacy Billing Ended June 30

For flu, pneumococcal, and COVID-19 vaccines furnished on or after July 1, 2023, to patients in a Medicare Part A-covered skilled nursing facility (SNF) stay, immunizers can no longer bill Medicare directly. Typical SNF consolidated billing regulations are in place, which require SNFs to bill for all services furnished to patients in a Medicare-covered SNF stay, including vaccines. Third-party suppliers furnishing these vaccines under arrangement with the SNF must seek payment from the SNF for their services. Immunizers may still bill Medicare directly for vaccines furnished before July 1, 2023.

During the COVID-19 public health emergency, outside immunizers helped fill the need to provide onsite vaccinations at SNFs. This enforcement discretion related to certain pharmacy billing ended June 30, 2023.


Medicare Providers: Deadlines for Joining an Accountable Care Organization

To participate in an Accountable Care Organization (ACO) for performance year 2024, work with an ACO to join their participant list. ACOs must submit their lists to CMS by August 1 at:

Participant taxpayer identification numbers can’t overlap multiple ACO participant lists. Resolve any overlaps by September 5.

More Information:


Help People with Disabilities Get the Care They Need

People living with disabilities face barriers to adequate health care, like not having access to a regular health care provider and routine check-ups (see CDC). As a result, they have poorer overall health outcomes, including increased likelihood of obesity (41.6%), diabetes (15.9%), and depression (43.0%) (see CDC). During the Americans with Disabilities Act anniversary month, find out how you can help address these challenges.

More Information:


MLN Matters® Articles

Corrections to Home Health Claims Edits

Learn about updates for claims with:

  • Condition code DR (disaster-related) and occurrence code 50
  • Admission source edits



Medicare & Mental Health Coverage — Revised

Learn what’s changed, including:

  • Where to get help for a mental health crisis
  • Information on:
    • End of the COVID-19 public health emergency
    • Chronic pain management
    • Behavioral health
    • Nurse practitioner qualification requirements
    • Interactive, audio-video technology services
  • New codes


From Our Federal Partners

Wildfire Smoke Exposure Poses Threat to At-Risk Populations

The CDC issued a Health Alert Network Health Advisory to remind health care professionals seeing patients affected by wildfire smoke to be alert to the possible adverse effects of smoke exposure, particularly among individuals at higher risk of severe outcomes. The alert provides recommendations for clinicians, health authorities, and the public.


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