CMS

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 June 22nd, The Centers for Medicare and Medicaid Services (CMS) released details describing how Medicare beneficiaries can obtain Medicare-covered drugs that may slow the progression of Alzheimer’s disease. Medicare will cover drugs with traditional FDA approval when a physician and clinical team participates in the collection of evidence about how these drugs work, also known as a registry. To get Medicare coverage people will need to 1) be enrolled in Medicare, 2) be diagnosed with mild cognitive impairment or mild Alzheimer’s disease dementia, and 3) have a physician participating in a registry with an appropriate clinical team and follow-up care...

On June 26th, CMS issued a proposed rule that proposes to update payment rates and policies and includes requests for information under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. For calendar year 2024, CMS is proposing to increase the ESRD PPS base rate to $269.99, increasing total payments to ESRD facilities by approximately 1.6 percent totaling $6.4 billion. The CY 2024 ESRD PPS proposed rule also includes several proposals and requests for information related to ESRD PPS payment policies. This rule also proposes an update to the Acute Kidney Injury dialysis payment rate for renal dialysis services furnished by ESRD...

The Administration for Community Living (ACL) and Centers for Medicare & Medicaid Services (CMS) announced actions to improve enrollment in the Extra Help with Medicare Prescription Drug Plan Costs program, also known as the Low-Income Subsidy. The Extra Help program provides eligible older adults and individuals with disabilities with help paying for their Medicare Part D prescription drug premiums and cost-sharing. Up to three million older adults and individuals with disabilities are eligible for the Extra Help program but are not enrolled. Actions to increase uptake of the program include targeted efforts to reach those eligible for the program, including individuals living in rural and underserved communities...

On June 8th, CMS announced a new voluntary primary care model called “Making Care Primary (MCP) Model”. The 10.5-year multi-payer model is designed to improve care and strengthen coordination between primary care clinicians, specialists, social service providers, and behavioral health clinicians as well as address individuals’ health-related social needs. CMS is testing the model in eight states— Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington—and will work with these states’ Medicaid agencies to align their programs with the new model in key areas. CMS plans to work with private payers in the future...

Today, the Department of Health and Human Services, through CMS, announced 43 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From July 1, 2023, through September 30, 2023, some people with Medicare who take these drugs may save between $1 and $449 per average dose, depending on the beneficiary’s coverage. Under the Inflation Reduction Act, signed into law in August 2022, drug companies that raise their drug prices faster than the rate of inflation are required to pay a rebate to Medicare. Starting July 1, 2023, Medicare beneficiaries may pay a lower coinsurance for certain Part B drugs if the drug’s price increased faster than the rate of inflation in a benchmark quarter.

CMS’ recent rule, released on May 23, proposes to lower the cost of prescription drugs covered by Medicaid by increasing price transparency. The proposed regulation would give CMS and states additional tools, like a drug price verification survey, which would verify drug prices to increase transparency about why the costs of certain drugs are expensive for Medicaid and help states better negotiate what the Medicaid program pays for high-cost drugs. CMS also proposes that contracts between states, Medicaid-managed care plans, and third-party contractors, such as pharmacy benefit managers (PBMs), reflect transparent reporting of drug payment information among third-party contractors...

On May 12, the Centers for Medicare & Medicaid Services (CMS) published a 15-page FAQ document for State Medicaid agencies on the end of the Medicaid continuous enrollment condition. The FAQ document provides additional information and clarification on the Medicaid redetermination and unwinding process. The FAQ includes guidance in the following areas: Returned mail condition, which was added by the CAA, 2023 into Section 6008(f)(2)(c) of the FFCRA and established a new condition for receiving the FFCRA temporary FMAP increase. Medicaid and CHIP resumption of premiums, and the modifications of the condition found in the CAA, 2023, and described in SHO#23-002. Renewals for individuals receiving SSI in Section 1634 States....

The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance for nursing home visitation ahead of the conclusion of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. The guidance emphasizes that despite the end of the PHE, nursing homes must continue to uphold infection control procedures and practices. The updated guidance advises nursing homes to follow CDC recommendations and post visual alerts to inform the public of infection control practices. Additionally, it states that indoor visitation during a COVID-19 outbreak should occur in the resident's room.

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin that describes the end dates of certain COVID-19-related Medicaid and the Children’s Health Insurance Program (CHIP) coverage and enhanced federal funding resulting from the May 11th PHE end date. The bulletin includes information on COVID-19 vaccines, vaccine administration, testing, and treatment; telehealth flexibilities; and implications of the end of the COVID-19 National Emergency for section 1135 waivers. Additional federal guidance on flexibilities enabled by the COVID-19 emergency declaration and how they will be impacted by the end of the COVID-19 PHE can be found here.