CMS

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.

On Monday, January 31st, CMS issued a final rule for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The MA RADV program is used to identify improper risk adjustment payments made to Medicare Advantage Organizations (MAOs) for claims made to Medicare without supporting evidence from a beneficiary’s medical record. Payments to MAOs are adjusted based on the health status of a MAO’s enrollees using medical diagnoses reported by the insurer. The new policy will apply to plan contracts since 2018.

As part of the continuing efforts under President Biden’s initiative to improve nursing home transparency, safety and quality, and accountability, the U.S. Department of Health and Human Services announced new actions to reduce the inappropriate use of antipsychotic medications and to bring greater transparency about nursing home citations to families. Beginning this month, CMS will conduct targeted, off-site audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis.

The FDA recently granted accelerated approval for the drug Leqembi, a medication intended to slow the progression of Alzheimer’s disease. Leqembi, the brand name for lecanemab, is the second Alzheimer’s therapy for individuals with mild cognitive impairment. Lequembi targets the protein amyloid and can be prescribed to patients in early to mid-stages of Alzheimer’s disease. Eisai, the manufacturer of Leqembi, reports that the drug will be available by January 23, 2023 and estimates the cost of the biweekly infusion to be $26,500 annually. Medicare coverage of Leqembi and other drugs like it, such as Aduhelm, that have accelerated FDA approval are limited to beneficiaries enrolled in certain clinical trials.

CMS added a new telehealth indicator on clinician profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). The new indicator helps beneficiaries and caregivers find clinicians who provide telehealth services. This is especially helpful for patients seeking telehealth due to the ongoing public health emergency,