CMS

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...

The Centers for Medicare & Medicaid Services (CMS) recently announced final 2024 payment rules for End-Stage Renal Disease (ESRD), Home Health, and Hospital Outpatient and Ambulatory Survey Center (ASC), as well as the Calendar Year (CY) 2024 Physician Fee Schedule (PFS). 1. ESRD Prospective Payment System (PPS) 2. Home Health Prospective Payment System (PPS) 3. Hospital Outpatient PPS and ASC Payment System 4. CY 2024 Medicare PFS

Enrollment for 2024 Health Insurance on the Marketplace opened November 1 and will continue through January 15, 2024. Consumers are encouraged to visit HealthCare.gov or a state-based marketplace if applicable to enroll if they are uninsured, lost their Medicaid or Children's Health Insurance Program (CHIP) coverage, or are looking to review health coverage options to meet their needs. CMS and HHS released tools, tips, and resources to help consumers find the best coverage options available to individuals and families in the federal Marketplace. Customers who enroll by December 15 will have coverage that begins January 1, 2024.

On Tuesday, October 31, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of July 2023, over 66.2 million people are enrolled in Medicare; nearly 34 million are enrolled in fee-for-service Medicare and more than 32.2 million have a Medicare Advantage plan. Over 91.5 million enrollees have Medicaid and CHIP. More than 84.5 million individuals have Medicaid and over seven 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 Friday, October 13, CMS issued a National Coverage Analysis decision memo outlining Medicare’s expansion of coverage for Positron Emission Tomography (PET) beta amyloid imaging, or scans for the protein that’s believed to contribute to Alzheimer’s disease. Since 2013, CMS has provided a one-time amyloid PET scan per patient; however, CMS will permit Medicare coverage determinations for this type of imaging to be made by the Medicare Administrative Contractors (MACs). Alzheimer’s disease (AD) is a currently irreversible, fatal brain disorder that progressively degrades memory, cognitive function (thinking and reasoning), and eventually motor function...

Medicare’s Open Enrollment Period, the time when Medicare beneficiaries can compare coverage options and choose health and drug plans, began on October 15, 2023, and ends on December 7, 2023. Medicare Advantage and Part D plan costs and covered benefits can change from year to year, so people with Medicare should look at their coverage choices and decide on the options that best meet their health needs for coverage starting January 1, 2024. To help people with Medicare compare health and prescription drug plans during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) recently released the 2024 Star Ratings for Medicare Advantage (Medicare Part C) plans and Medicare Part D plans....

Last week, the Centers for Medicare & Medicaid Services (CMS) published the “Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2020”, and the Medicaid Section “1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2018-2019.” These reports discuss the long-term services and supports (LTSS) rebalancing trends and patterns in expenditures for different home and community-based services (HCBS) and institutional care, nationally and across states....

The Centers for Medicare & Medicaid Services (CMS) has posted a draft state critical incident management system (CIMS) survey for public comment. This draft survey will be a follow-up to the state survey conducted in 2019. The purpose of the survey is to identify current methods and new promising practices for identifying, reporting, tracking, and resolving incidents of abuse, neglect, and exploitation. We expect the survey will be finalized and issued for states to complete in spring 2024. Comments are due to CMS by Monday, December 4.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center’s “Making Care Primary (MCP) Model” team will be answering questions about the forthcoming model in an Office Hours webinar on Tuesday, October 24 at 2:00 p.m. ET. A link to register for the event will be sent via listserv once available. In addition to the live Q&A, attendees will be able to submit questions in advance upon registering. The CMS Innovation Center is currently accepting applications for the Making Care Primary (MCP) Model. Interested organizations are encouraged to begin their applications even if they are not prepared to submit at this time; doing so helps CMS provide more tailored support to applicants. Interested organizations must submit their...

The Centers for Medicare & Medicaid Services (CMS) has posted proposed updates to the 1915(c) Waiver Application and Technical Guide for public comment. Comments are due to CMS by Monday, November 13. CMS is proposing technical updates and revisions throughout both documents to align with current requirements, such as adding an option for states to indicate whether HCBS can be delivered via telehealth, removing references to Statewide Transition Plans, and integrating settings criteria with person-centered service planning requirements.