Medicare

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,

The annual Medicare open enrollment period for Medicare Advantage and Part D plans ends Wednesday, December 7, 2022. To assist individuals who counsel Medicare clients, the National Council on Aging or NCOA developed a “Medicare Open Enrollment Toolkit”. The Toolkit includes many useful resources designed for professionals, advocates, caregivers, and/or older adults, including a fact sheet on changes to Medicare in 2023; information on Medicare Part A and Part B premiums and cost-sharing in 2023; a 2023 Medicare Part D cost-sharing chart; and other helpful information and guidance.

This week CMS issued a final rule for the Calendar Year 2023 Physician Fee Schedule which includes updates and policy changes for Medicare payments and other Part B issues. Some of the changes include expanding access to behavioral health services by allowing certain health practitioners to provide and manage a beneficiary’s behavioral health needs; extending several telehealth services that are temporarily available for the COVID-19 public health emergency at least through calendar year 2023; and clarifying payment for dental examinations and treatments in more circumstances, such as prior to organ transplants and certain cardiac procedures beginning in calendar year 2023.

On September 26, 2022, in an effort to improve nursing home transparency, safety, quality, and accountability, the U.S. Department of Health and Human Services made additional data publicly available that provides information about the ownership of all Medicare-certified nursing homes. This data will give state licensing officials, state and federal law enforcement, researchers, and the public the ability to identify common owners of nursing homes across multiple locations. This data can help to identify the performance of facilities under common ownership, including owners affiliated with multiple nursing homes with a record of poor performance.

The Kaiser Family Foundation's new report, “Beneficiary Experience, Affordability, Utilization, and Quality in Medicare Advantage and Traditional Medicare: A Review of the Literature,” details their findings from an analysis of 62 studies published since 2016 comparing traditional Medicare to Medicare Advantage. The analysis reviewed beneficiary experience, affordability, service utilization, and quality measures. According to the report, the review “found few differences between Medicare Advantage and traditional Medicare that are supported by strong evidence or have been replicated across multiple studies. Both Medicare Advantage and traditional Medicare beneficiaries reported similar rates of satisfaction.

This brief highlights key provisions of the federal Inflation Reduction Act of 2022, recently signed into law by President Biden. The law includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, beginning in 2023. This brief examines the potential impact of these provisions for Medicare beneficiaries nationally and by state.

On July 19, 2022 MedPAC released its July 2022 Data Book on Health Care Spending and the Medicare Program. This publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries’ access to care, and Medicare program quality. Section 4 (pages 31-38) covers dually eligible individuals and includes information on the percentage of Medicare spending for this population, demographic data, health status, and service use. Within this section, states may be specifically interested in Chart 4-4: Demographic differences between dual-eligible beneficiaries and non-dual-eligible beneficiaries, 2019.

On Monday, June 27, 2022 the Biden Administration announced a new model aimed at improving cancer care for Medicare patients and lowering health care costs. CMS’ Center for Medicare and Medicaid Innovation designed the Enhancing Oncology Model (EOM) to test how to improve health care providers’ ability to deliver patient-centered care and consider patients’ unique needs. The model will focus on supporting patients, caregivers, and survivors, while addressing inequities and providing patients with treatments that address their individual needs.