CMS

The CMS Innovation Center announced that the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030. Changes intended to address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness will be announced by the Innovation Center when available.

On March 15th, the Department of Health and Human Services, through CMS, announced 27 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From April 1, 2023 through June 30, 2023, some people with Medicare who take these drugs may save between $2 and $390 per average dose, depending on the beneficiary’s coverage. Under the Inflation Reduction Act, signed into law in August 2022, drug companies that raise their drug prices faster than the rate of information are required to pay a rebate to Medicare. Starting April 1, 2023, Medicare beneficiaries may pay a lower coinsurance for certain Part B drugs if the drug’s price increased faster than the rate of inflation in a benchmark quarter.

On Monday, February 27th, CMS released a fact sheet titled “CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency”. The fact sheet includes information on several topics including COVID-19 vaccines, testing, and treatments, telehealth services, health care access, including continued flexibilities for health care professionals, and information on the Inpatient Hospital Care at Home initiative. CMS reports that in the coming weeks the agency will host stakeholder calls and office hours to provide additional information.

CMS recently released a proposed National Coverage Determination (NCD) decision that would, for the first time, expand coverage for power seat elevation equipment on certain power wheelchairs to Medicare individuals. The proposed NCD is open for public comment for 30 days and will end on March 17, 2023. If finalized, power seat elevation equipment would be covered by Medicare for individuals with a Group 3 power wheelchair, which are designed to meet the needs of people with Medicare with severe disabilities, to improve their health as they transfer from the wheelchair to other surfaces.

On Monday, February 13, 2023 The Centers for Medicare & Medicaid Services released a press release on the Biden-Harris administration’s efforts to implement section 6101(a) of the Affordable Care Act. The proposed rule would require additional ownership and management information about nursing homes across the United States be disclosed. The Administrations attempts to implement the rule is part of a continued effort by the administration to improve quality of care at nursing homes.

Yesterday the Centers for Medicare & Medicaid Services (CMS) announced next steps describing how the agency will implement the new Medicare Prescription Drug Inflation Rebate Program, including a timeline of key dates. As part of the Inflation Reduction Act (IRA) of 2022 (P.L. 117-169), the Medicare Prescription Drug Inflation Rebate Program requires drug companies to pay a rebate to Medicare if they raise prices for certain drugs faster than the rate of inflation. Based on a 12 month period starting October 1, 2022, drug companies will be required to pay rebates to Medicare for raising prices that outpace inflation on certain Part D drugs.

The Centers for Medicare & Medicaid Services (CMS) recently released seven new resources focused on strengthening the DSW. The online training, Recruiting, Selecting, and Retaining Direct Service Workers to Provide Self-directed Home and Community-Based Services (HCBS), provides guidance and information for people who self-direct, or wish to self-direct, their HCBS, as well as others interested in information on finding, hiring, and retaining direct service workers. You can access all of these resources from CMS’ Direct Care Workforce page and ADvancing States' HCBS Clearinghouse.

In light of the Biden-Harris Administration announcing their intent to end the public health emergency (PHE), CMS has created a suite of updated resources to provide guidance around the unwinding. All tools can be found on the CMS Emergencies Page of their website. Guidance includes but is not limited to, a fact sheet for information about PHE waiver flexibilities, Acute Hospital at Home information, and the CMS 1135 Waiver/ Flexibility request inquiry form. The CMS Emergencies Page will be updated continuously as the end of the PHE nears. CMS encourages regular visits to the page for the most up to date information regarding PHE unwinding.

This past Tuesday, the Centers for Medicare & Medicaid Services (CMS) announce the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). As of October 24, 2022, over 65.2 million people are enrolled in Medicare, an increase of 132,757 since the last report. More than 35 million people are enrolled in Original or Fee-for-Service Medicare, and more than 30.2 million are enrolled in a Medicare Advantage or other health plan. Over 91.3 million enrollees have Medicaid (84.3+ million) and Children’s Health Insurance Program (CHIP) (7.0+ million), an increase of 462,322 since the last report. More than 12 million enrollees are eligible for both Medicare and Medicaid and are counted for both programs.

This past Wednesday, February 1st, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.