Medicare

On November 6, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise the Medicare Advantage (MA) Program, Medicare Part D, Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. The proposed rule aims to strengthen beneficiary protections and guardrails to promote healthy competition and ensure MA plans best meet the needs of beneficiaries. It seeks to increase the percentage of dually eligible individuals enrolled in managed care who receive both Medicare and Medicaid services through the same organization...

On November 8, KFF released the issue brief, “Medicare Advantage 2024 Spotlight: First Look”, detailing the organization’s analysis of Medicare Advantage (MA) plans and Part D prescription drug plans (PDPs) available in 2024. The analysis revealed that nationwide the typical beneficiary has a choice of 43 Medicare Advantage plans as an alternative to traditional Medicare for 2024; the same number available as in 2023, but more than double the number of plans offered in 2018. Of the 43 MA plans, 36 plans offer Part D drug coverage, on average. Additionally, individuals with traditional Medicare have a choice of 21 Medicare stand-along PDPs for 2024.

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....

On Tuesday, June 29, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of March 2023, over 65.7 million people are enrolled in Medicare; nearly 34 million are enrolled in fee-for-service Medicare and more than 31.7 have a Medicare Advantage plan. Over 93.8 million enrollees have Medicaid and CHIP; more than 86.7 million individuals have Medicaid and more than 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.

On March 31st, the Board of Trustees for Medicare released their most recent report to Congress on the financial operations and actuarial status of Medicare. The Trustees Report describes past and estimated future financial operations of the Hospital Insurance (HI) (Part A) and Supplementary Medical Insurance (SMI) (Part B and prescription drug coverage) trust funds. According to the report, the Medicare HI trust fund will have funds to pay for Part A benefits until 2031, three years longer than what was reported last year due to higher projected HI income and lower expenditures. However, the Trustees project deficits in the HI trust fund starting in 2025.

the MMCO submitted its FY 2022 Medicare-Medicaid Coordination Office Report to Congress, as required by statute. Federal statute established the Federal Coordinated Health Care Office or MMCO within CMS to improve the coordination between the federal government and states to enhance access to quality services for individuals dually eligible for both Medicare and Medicaid benefits. The report describes MMCO’s activities to better serve dually eligible individuals in 2022 and contains three legislative recommendations, which were proposed in the Presidents Fiscal Year (FY) 2024 Budget.

CMS issued a proposed rule (CMS-1787-P) that would update Medicare hospice payments and the aggregate cap amount for FY 2024 in accordance with existing statutory and regulatory requirements. This rule includes information on hospice utilization trends and solicits comments regarding information related to the provision of higher levels of hospice care, spending patterns for non-hospice services provided during the election of the hospice benefit, ownership transparency, equipping patients and caregivers with information to inform hospice election decision-making selection, and ways to examine health equity under the hospice benefit. This rule also proposes conforming regulations text changes related to the expiration of the COVID-19 PHE.

On March 15, CMS released initial guidance describing the requirements and parameters on key elements of the new Medicare Drug Price Negotiation Program for 2026. The initial program guidance describes the requirements and procedures for the first set of negotiations, which will occur during 2023 and 2024 and result in prices effective in 2026.

AARP’s Public Policy Institute released a report titled “Underused Medicare Savings Programs Can Help Many More Older Adults Afford Health Care”. Medicare Savings Programs or MSPs provide financial assistance with certain Medicare costs for eligible low-income Medicare beneficiaries, and are administered by state Medicaid agencies. According to the report, about 16 percent of all Medicare beneficiaries are enrolled in MSPs; however, the number of individuals eligible for these programs is estimated to be much higher. The paper discusses the findings from the organization’s analysis and research, and proposes areas states can consider to increase enrollment and expand eligibility.

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,