CMS

Today, the Department of Health and Human Services, through CMS, announced 43 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From July 1, 2023, through September 30, 2023, some people with Medicare who take these drugs may save between $1 and $449 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 inflation are required to pay a rebate to Medicare. Starting July 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.

CMS’ recent rule, released on May 23, proposes to lower the cost of prescription drugs covered by Medicaid by increasing price transparency. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, which would verify drug prices to increase transparency about why the costs of certain drugs are expensive for Medicaid and help states better negotiate what the Medicaid program pays for high-cost drugs. CMS also proposes that contracts between states, Medicaid-managed care plans, and third-party contractors, such as pharmacy benefit managers (PBMs), reflect transparent reporting of drug payment information among third-party contractors...

On May 12, the Centers for Medicare & Medicaid Services (CMS) published a 15-page FAQ document for State Medicaid agencies on the end of the Medicaid continuous enrollment condition. The FAQ document provides additional information and clarification on the Medicaid redetermination and unwinding process. The FAQ includes guidance in the following areas: Returned mail condition, which was added by the CAA, 2023 into Section 6008(f)(2)(c) of the FFCRA and established a new condition for receiving the FFCRA temporary FMAP increase. Medicaid and CHIP resumption of premiums, and the modifications of the condition found in the CAA, 2023, and described in SHO#23-002. Renewals for individuals receiving SSI in Section 1634 States....

The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance for nursing home visitation ahead of the conclusion of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. The guidance emphasizes that despite the end of the PHE, nursing homes must continue to uphold infection control procedures and practices. The updated guidance advises nursing homes to follow CDC recommendations and post visual alerts to inform the public of infection control practices. Additionally, it states that indoor visitation during a COVID-19 outbreak should occur in the resident's room.

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin that describes the end dates of certain COVID-19-related Medicaid and the Children’s Health Insurance Program (CHIP) coverage and enhanced federal funding resulting from the May 11th PHE end date. The bulletin includes information on COVID-19 vaccines, vaccine administration, testing, and treatment; telehealth flexibilities; and implications of the end of the COVID-19 National Emergency for section 1135 waivers. Additional federal guidance on flexibilities enabled by the COVID-19 emergency declaration and how they will be impacted by the end of the COVID-19 PHE can be found here.

On May 11th, The Centers for Medicare & Medicaid Services (CMS) released updated 2023 SSI and spousal impoverishment standards. Certain Medicaid income and resource standards are adjusted annually in accordance with changes in the SSI federal benefit rate and the Consumer Price Index, reflecting an effective date of January 1, 2023. Additionally, per section 1924 of the Social Security Act, the community spouse’s minimum monthly maintenance needs allowance (MMMNA) is adjusted based on changes to the federal poverty level and reflects a July 1, 2023 effective date. Additionally, the community spouse’s monthly housing allowance, calculated based on a percentage of the MMMNA, is adjusted each July 1st.

CMS issued the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system Reporting (IQR) program and are meaningful electronic health record (EHR) users is projected to be 2.8% for FY 2024. Hospitals may be subject to payment adjustments under the IPPS. The proposed increase in operating and capital IPPS payment rates will generally increase hospital payments in FY 2024 by $3.3 billion.

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.