CMS

On September 1, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to establish staffing requirements, including national minimum nurse staffing standards, for nursing facilities. Nursing facilities participating in Medicare and Medicaid would be required to: provide residents with a minimum of 0.55 hours of care from a registered nurse (RN) per resident per day (hours per resident day or HPRD) and 2.45 hours of care from a nurse aide (NA) per resident per day; have a registered nurse onsite 24 hours per day, seven days per week to provide direct resident care; and complete facility assessments on staffing needs. CMS proposes that implementation of the final requirements will occur in three phases over a three-year...

The Centers for Medicare & Medicaid Services (CMS) recently announced the first 10 drugs covered under the Medicare Part D prescription drug benefit selected for negotiation. As a result of the Inflation Reduction Act (P.L. 117-169), Medicare, for the first time, has the ability to directly negotiate prices of certain high expenditure, single source drugs without generic or biosimilar competition, based on total gross covered prescription drug costs under Medicare Part D and other criteria as required by the law. The negotiations with participating drug companies will occur in 2023 and 2024, and any negotiated prices will become effective beginning in 2026. The negotiation process will consider the selected drug’s clinical benefit...

The Centers for Medicare & Medicaid Services (CMS) has released a Request for Applications (RFA) detailing model payment, care delivery, quality, and other policies for the Making Care Primary (MCP) Model. CMS announced the new voluntary primary care model in June to improve care and strengthen coordination between primary care clinicians, specialists, social service providers, and behavioral health clinicians as well as address individuals’ health-related social needs. Stating July 1, 2024, CMS will test the 10.5 year model in eight states— Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington—and will work with these states’ Medicaid agencies to align their programs with the new model...

The CMS fact sheet notes the one-year anniversary of the Inflation Reduction Act (IRA) of 2022 and describes provisions in the law affecting Medicare and Marketplace plans, including a summary of milestones CMS has met. A list of public education tools to help people with Medicare and those who assist them in understanding the changes under the IRA are included.

CMS recently issued several final rules on payment rates and policies fiscal year for (FY) 2024. 1. FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1785-F and CMS-1788-F Fact Sheet 2. Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System Final Rule - CMS-1779-F 3. Fiscal Year 2024 Hospice Payment Rate Update Final Rule (CMS-1787-F) 4. Fiscal Year 2024 Medicare Inpatient Psychiatric Facility Prospective Payment System and Quality Reporting Final Rule 5. Fiscal Year 2024 Inpatient Rehabilitation Facility Prospective Payment System Final Rule (CMS-1781-F)

The Centers for Medicare & Medicaid Services (CMS) recently issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule. The proposed rule updates Medicare payment policies and rates for Home Health Agencies (HHAs) and other . Estimated Medicare payments to HHAs in CY 2024 would decrease in the aggregate by 2.2 percent, or $375 million compared to CY 2023, based on the proposed policies. The proposed rule also adds new quality reporting program measures, including a measure on the percent of patients/residents who are up to date with the COVID-19 vaccine, and proposes certain technical changes....

CMS projects the calendar year 2024 average total monthly premium for Medicare Part D prescription drug coverage to be $55.40; a decrease of 1.8 percent from 2023. The average total Part D premium is the sum of the average basic premium and the average supplemental premium for plans with enhanced coverage. CMS reports that the projected decrease in the average total Part D premium is due to a limit in the growth of the base beneficiary premium to an annual six percent increase and other changes to the Part D benefit in 2024 as specified by the Inflation Reduction Act. Additionally, in 2024 CMS’ Part D pharmacy price concessions policy is expected to reduce beneficiary out-of-pocket costs by requiring Part D plans to apply all price...

On Monday, July 31, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of April 2023, over 65.8 million people are enrolled in Medicare; more than 33.9 million are enrolled in fee-for-service Medicare and more than 31.9 have a Medicare Advantage plan. Over 94.1 million enrollees have Medicaid and CHIP; more than 87 million individuals have Medicaid and nearly 7.1 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs...

This week, the Centers for Medicare & Medicaid Services (CMS) announced that Appendix K flexibilities currently scheduled to end on Nov. 11, 2023 may be extended, if a state takes action by Nov. 11, 2023 to permanently incorporate desired Appendix K provisions into their 1915(c) programs. The applicable Appendix K flexibilities will remain in place until the effective date of the 1915(c) waiver amendment or renewal...

This week, CMS announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through care coordination and management, caregiver support, and respite services. Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. The intended beneficiary population is community-dwelling Medicare fee-for-service beneficiaries, including beneficiaries dually eligible for Medicare...