Fact Sheets

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Advocacy Tips for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care

The Center for Medicare Advocacy (CMA) recently released a tip sheet providing guidance to Medicare Advantage (MA) enrollees facing difficulty obtaining in-network care. This article addresses the complexities of MA plans, which can restrict enrollees to contracted networks of healthcare providers. Despite strengthened regulations by the Centers for Medicare & Medicaid Services (CMS) requiring MA plans to cover necessary care outside the network under specific circumstances, recent reports indicate issues with network adequacy. CMA emphasizes the importance of MA enrollees and advocates utilizing consumer protections, reporting difficulties in obtaining necessary care, and urging CMS to publicize and enforce these rights.

Short URL: http://www.advancingstates.org/node/75253

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CMS Announces New Model to Advance Integration in Behavioral Health

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) recently announced a new state-based model, Innovation in Behavioral Health (IBH), to test approaches for addressing behavioral and physical health, as well as health-related social needs among the Medicaid and Medicare populations. The IBH Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorder by connecting them with the physical, behavioral, and social supports needed to manage their care. The model will also promote health information technology capacity building through infrastructure payments and other activities...

Short URL: http://www.advancingstates.org/node/75241

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CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

On January 17, the Centers for Medicare & Medicaid Services (CMS) released the “CMS Interoperability and Prior Authorization Final Rule” (CMS-0057-F) to improve the electronic exchange of health information and prior authorization process for medical items and services. The final rule applies to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). This final rule establishes requirements for certain payers to streamline the prior authorization process generally starting January 2026 and complements the Medicare...

Short URL: http://www.advancingstates.org/node/75236

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Age-Related Forgetfulness or Signs of Dementia?

Older adults may worry about their memory and other thinking abilities, such as taking longer to learn something new. These changes are usually signs of mild forgetfulness — or age-related forgetfulness — and are often a normal part of aging. However, more serious memory problems could be due to mild cognitive impairment, dementia such as Alzheimer’s disease, or other factors beyond normal aging. Many older adults can become more forgetful as they age, which is why it is important to learn the differences between age-related forgetfulness and signs of dementia. The National Institute on Aging (NIA) recently released an infographic to help differentiate between age-related forgetfulness and signs of dementia.

Short URL: http://www.advancingstates.org/node/75229

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Marketplace 2024 Open Enrollment Period Report: National Snapshot

The Centers for Medicare & Medicaid Services (CMS) reports that over 20 million Americans have signed up for 2024 individual market health insurance coverage through the Marketplaces since the start of the 2024 Marketplace Open Enrollment Period (OEP) on November 1. This includes 15.5 million Marketplace plan selections in the 32 states using the HealthCare.gov platform for the 2024 plan year and 4.8 million plan selections in the 18 states and the District of Columbia with state-based Marketplaces (SBMs) that are using their own eligibility and enrollment platforms, through December 23, 2023 (Week 8). Total nationwide plan selections include 3.7 million consumers (18% of total) who are new to the Marketplaces for 2024...

Short URL: http://www.advancingstates.org/node/75224

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4 Steps to Combat Loneliness in Older Adults

The National Council on Aging (NCOA)’s article “Your Mental Health This Holiday and Beyond: 4 Steps to Combat Loneliness in Seniors” notes that loneliness among older adults can be difficult during the holidays, especially for individuals who live alone. The U.S. Census estimates that as many as 27% of adults age 65 and older lived alone in 2020; however, a person may experience loneliness even if they live with other people. Loneliness can affect anyone who doesn’t feel meaningful connections with others. NCOA’s article shares four tips for staying connected with loved ones during this holiday season, including prioritizing communication, facilitating social activities through local organizations...

Short URL: http://www.advancingstates.org/node/75180

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Rights and Wrongs in Medicaid-Funded Assisted Living

Justice in Aging has released a fact sheet focusing on Medicaid-funded assisted living facilities and their compliance with federal laws. This resource equips residents and their representatives with advocacy tools to ensure facilities follow the law and treat residents appropriately. Although this guide focuses on assisted living, the relevant federal laws cover any similar residential setting reimbursed through Medicaid HCBS. Accordingly, this guide’s advice generally applies also to HCBS-funded facilities for persons with disabilities, such as group homes and adult residential facilities...

Short URL: http://www.advancingstates.org/node/75172

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National Health Expenditures 2022 Highlights

The Centers for Medicare & Medicaid Services (CMS) recently shared information on national health expenditures in 2022, highlighting a 4.1% growth in U.S. health care spending to $4.5 trillion. This growth, while faster than the increase of 3.2% in 2021, was notably slower than the substantial increase of 10.6% witnessed in 2020. CMS noted the growth in 2022 reflected strong growth in Medicaid and private health insurance spending that was somewhat offset by continued declines in supplemental funding by the federal government associated with the COVID-19 pandemic. The fact sheet also notes that in 2022, the insured share of the population reached a historic high of 92%...

Short URL: http://www.advancingstates.org/node/75168

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Reduced Coinsurance for Certain Part B Rebatable Drugs under the Medicare Prescription Drug Inflation Rebate Program

The Centers for Medicare & Medicaid Services (CMS) recently released revised guidance detailing key requirements and procedures for calculating rebates and invoicing manufacturers that owe rebates to Medicare under the Medicare Prescription Drug Inflation Rebate Program for certain drugs covered under Medicare Part B and Part D. CMS also released the list of 48 prescription drugs for which Part B beneficiary coinsurances may be lower between January 1, 2024 and March 31, 2024. Some people with Medicare who take these drugs may save between $1 and $2,786 per average dose starting January 1, 2024, depending on their individual coverage.

Short URL: http://www.advancingstates.org/node/75161

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Visiting Residents in Long-Term Care Facilities During the Holidays

A recently published fact sheet from the National Consumer Voice for Long-Term Quality Care offers guidance for visiting residents in long-term care facilities during the holiday season. This fact sheet outlines the importance of visits from family members in supporting residents’ emotional well-being and ensuring that residents receive quality care. It also emphasizes the rights of residents and family members to determine what visits involve and when they take place. Additionally, Consumer Voice provides practical tips and activity ideas for family visits, along with suggestions for engaging residents during the gift-giving season, including examples of suitable gifts for residents.

Short URL: http://www.advancingstates.org/node/75151


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