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CMS Announces Final Medicare Payment Rules for Several Provider Types & Services

The Centers for Medicare & Medicaid Services (CMS) recently announced final 2024 payment rules for End-Stage Renal Disease (ESRD), Home Health, and Hospital Outpatient and Ambulatory Survey Center (ASC), as well as the Calendar Year (CY) 2024 Physician Fee Schedule (PFS). 1. ESRD Prospective Payment System (PPS) 2. Home Health Prospective Payment System (PPS) 3. Hospital Outpatient PPS and ASC Payment System 4. CY 2024 Medicare PFS

Short URL: http://www.advancingstates.org/node/75064

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Health Insurance Marketplace Open Enrollment Period Begins

Enrollment for 2024 Health Insurance on the Marketplace opened November 1 and will continue through January 15, 2024. Consumers are encouraged to visit HealthCare.gov or a state-based marketplace if applicable to enroll if they are uninsured, lost their Medicaid or Children's Health Insurance Program (CHIP) coverage, or are looking to review health coverage options to meet their needs. CMS and HHS released tools, tips, and resources to help consumers find the best coverage options available to individuals and families in the federal Marketplace. Customers who enroll by December 15 will have coverage that begins January 1, 2024.

Short URL: http://www.advancingstates.org/node/75048

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CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP)

On Tuesday, October 31, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of July 2023, over 66.2 million people are enrolled in Medicare; nearly 34 million are enrolled in fee-for-service Medicare and more than 32.2 million have a Medicare Advantage plan. Over 91.5 million enrollees have Medicaid and CHIP. More than 84.5 million individuals have Medicaid and over seven 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.

Short URL: http://www.advancingstates.org/node/75025

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CMS Broadens Coverage of PET Scans for Alzheimer’s Patients

On Friday, October 13, CMS issued a National Coverage Analysis decision memo outlining Medicare’s expansion of coverage for Positron Emission Tomography (PET) beta amyloid imaging, or scans for the protein that’s believed to contribute to Alzheimer’s disease. Since 2013, CMS has provided a one-time amyloid PET scan per patient; however, CMS will permit Medicare coverage determinations for this type of imaging to be made by the Medicare Administrative Contractors (MACs). Alzheimer’s disease (AD) is a currently irreversible, fatal brain disorder that progressively degrades memory, cognitive function (thinking and reasoning), and eventually motor function...

Short URL: http://www.advancingstates.org/node/75000

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Medicare Open Enrollment Begins

Medicare’s Open Enrollment Period, the time when Medicare beneficiaries can compare coverage options and choose health and drug plans, began on October 15, 2023, and ends on December 7, 2023. Medicare Advantage and Part D plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices and decide on the options that best meet their health needs for coverage starting January 1, 2024. To help people with Medicare compare health and prescription drug plans during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) recently released the 2024 Star Ratings for Medicare Advantage (Medicare Part C) plans and Medicare Part D plans....

Short URL: http://www.advancingstates.org/node/74998

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Release of the Medicaid LTSS Annual Expenditures Report and Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report

Last week, the Centers for Medicare & Medicaid Services (CMS) published the “Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2020”, and the Medicaid Section “1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2018-2019.” These reports discuss the long-term services and supports (LTSS) rebalancing trends and patterns in expenditures for different home and community-based services (HCBS) and institutional care, nationally and across states....

Short URL: http://www.advancingstates.org/node/74995

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CMS Posts Draft Critical Incident Management System Survey for Public Comment

The Centers for Medicare & Medicaid Services (CMS) has posted a draft state critical incident management system (CIMS) survey for public comment. This draft survey will be a follow-up to the state survey conducted in 2019. The purpose of the survey is to identify current methods and new promising practices for identifying, reporting, tracking, and resolving incidents of abuse, neglect, and exploitation. We expect the survey will be finalized and issued for states to complete in spring 2024. Comments are due to CMS by Monday, December 4.

Short URL: http://www.advancingstates.org/node/74978

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Upcoming: Making Care Primary (MCP) Model Office Hours

The Centers for Medicare & Medicaid Services (CMS) Innovation Center’s “Making Care Primary (MCP) Model” team will be answering questions about the forthcoming model in an Office Hours webinar on Tuesday, October 24 at 2:00 p.m. ET. A link to register for the event will be sent via listserv once available. In addition to the live Q&A, attendees will be able to submit questions in advance upon registering. The CMS Innovation Center is currently accepting applications for the Making Care Primary (MCP) Model. Interested organizations are encouraged to begin their applications even if they are not prepared to submit at this time; doing so helps CMS provide more tailored support to applicants. Interested organizations must submit their...

Short URL: http://www.advancingstates.org/node/74963

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CMS Proposes Revisions to 1915(c) Waiver Application and Technical Guide

The Centers for Medicare & Medicaid Services (CMS) has posted proposed updates to the 1915(c) Waiver Application and Technical Guide for public comment. Comments are due to CMS by Monday, November 13. CMS is proposing technical updates and revisions throughout both documents to align with current requirements, such as adding an option for states to indicate whether HCBS can be delivered via telehealth, removing references to Statewide Transition Plans, and integrating settings criteria with person-centered service planning requirements.

Short URL: http://www.advancingstates.org/node/74955

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CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies

The Departments of Health and Human Services (HHS), Labor, and the Treasury are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information solicits comment on access to a range of OTC items recommended by experts for preventive care that can be purchased without a prescription, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies.

Short URL: http://www.advancingstates.org/node/74950

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