Advocates

On Monday, January 31st, CMS issued a final rule for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The MA RADV program is used to identify improper risk adjustment payments made to Medicare Advantage Organizations (MAOs) for claims made to Medicare without supporting evidence from a beneficiary’s medical record. Payments to MAOs are adjusted based on the health status of a MAO’s enrollees using medical diagnoses reported by the insurer. The new policy will apply to plan contracts since 2018.

Elder financial exploitation threatens the financial security of millions of older Americans annually. CFPB has released updated resources for elder fraud prevention and response networks, including a report on the network collaboration and a streamlined virtual Network Development Guide.

The Center for Health Care Strategies has released a summary of its top 10 resources from 2022 that outline opportunities to strengthen the U.S health care system, particularly for Medicaid beneficiaries.

The Commonwealth Fund has published a compilation of state successes in transforming long-term care as a resource to support policymakers. This policy guide is the result of a nine-month partnership between CSG and the Commonwealth Fund. Subject matter experts and stakeholders from Arizona, Georgia, Hawaii, Indiana, Minnesota, New York, Pennsylvania and Virginia examine the following focus areas in long-term care: Addressing State Regulation of Long-Term Services and Supports Facilities; Optimizing American Rescue Plan Act Spending on Home- and Community-Based Services Under Medicaid; and Revitalizing the Direct Care Workforce and Supporting Family Caregivers.

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,

On January 5, 2023 CMS released a State Medicaid Director’s letter that provides a new reporting and oversight framework for states that permit managed care plans to deliver in-lieu-of services (ILOS) to their enrollees. ILOS are cost-effective substitutes for otherwise covered State plan services that may enhance enrollee’s health and wellbeing (for example, medically-tailored meals that enhance the ability of an enrollee to remain at home rather than in an institutional setting). States using ILOS will be required to limit them to no more than 5% of a managed care program’s total capitation payments and provide evaluative data to CMS about their effectiveness beginning in 2027.

On January 5, 2023 CMS released an Informational Bulletin providing further guidance on the Medicaid eligibility provisions in the recently-enacted Federal budget (Consolidated Appropriations Act of 2023). The CAA permits states to begin terminating Medicaid eligibility for current recipients on April 1, 2023 and provides gradually-decreased FMAP increases through December, 2023. This IB is the first in a series of written guidance from CMS on these provisions, focusing first on revised key due dates for certain state eligibility redetermination deliverables and activities.

The Center for Health Care Strategies, with support from the New York Health Foundation and in partnership with ATW Health Solutions, assisted seven New York-based health care organizations in piloting strategies for engaging patients of color to advance health equity. This CHCS brief outlines considerations for health care organizations in developing patient engagement strategies, including: (1) building trust with patient partners over time; (2) tailoring outreach strategies; (3) using-trauma-informed approaches; (4) engaging patients in data use; and (5) approaching engagement with humility.

On December 20, 2022 CMS released a report summarizing the public comments it received in response to the 2022 Request for Information (RFI): Access to Coverage and Care in Medicaid & CHIP. CMS framed the RFI questions across three dimensions of health care access: (1) enrolling in coverage, (2) maintaining coverage, and (3) accessing services and supports. This report includes counts of comments, types of respondents, summaries of common themes across objectives, and cross-cutting findings.

In 2017, Reading Hospital was awarded a $4.5 million grant from CMS to implement the Accountable Health Communities (AHC) model and assess whether addressing the health-related social needs of local Medicare and Medicaid beneficiaries would impact their healthcare costs and inpatient and outpatient healthcare utilization. This case study looks at 747 patients with resolved food needs and finds that among this cohort, emergency department visits dropped 32%, hospital admissions decreased 32%, readmissions were reduced by 30%, and hospital costs went down 31%. Among the patients who were also on the Diabetes Registry, A1C rates decreased by an average of 2.2%