CMS

On May 11th, The Centers for Medicare & Medicaid Services (CMS) released updated 2023 SSI and spousal impoverishment standards. Certain Medicaid income and resource standards are adjusted annually in accordance with changes in the SSI federal benefit rate and the Consumer Price Index, reflecting an effective date of January 1, 2023. Additionally, per section 1924 of the Social Security Act, the community spouse’s minimum monthly maintenance needs allowance (MMMNA) is adjusted based on changes to the federal poverty level and reflects a July 1, 2023 effective date. Additionally, the community spouse’s monthly housing allowance, calculated based on a percentage of the MMMNA, is adjusted each July 1st.

CMS issued the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system Reporting (IQR) program and are meaningful electronic health record (EHR) users is projected to be 2.8% for FY 2024. Hospitals may be subject to payment adjustments under the IPPS. The proposed increase in operating and capital IPPS payment rates will generally increase hospital payments in FY 2024 by $3.3 billion.

The CMS Innovation Center announced that the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model will be extended for calendar years 2025 through 2030. Changes intended to address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness will be announced by the Innovation Center when available.

On March 15th, the Department of Health and Human Services, through CMS, announced 27 prescription drugs covered under Medicare Part B that may have lower beneficiary coinsurances. From April 1, 2023 through June 30, 2023, some people with Medicare who take these drugs may save between $2 and $390 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 information are required to pay a rebate to Medicare. Starting April 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.

On Monday, February 27th, CMS released a fact sheet titled “CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency”. The fact sheet includes information on several topics including COVID-19 vaccines, testing, and treatments, telehealth services, health care access, including continued flexibilities for health care professionals, and information on the Inpatient Hospital Care at Home initiative. CMS reports that in the coming weeks the agency will host stakeholder calls and office hours to provide additional information.

CMS recently released a proposed National Coverage Determination (NCD) decision that would, for the first time, expand coverage for power seat elevation equipment on certain power wheelchairs to Medicare individuals. The proposed NCD is open for public comment for 30 days and will end on March 17, 2023. If finalized, power seat elevation equipment would be covered by Medicare for individuals with a Group 3 power wheelchair, which are designed to meet the needs of people with Medicare with severe disabilities, to improve their health as they transfer from the wheelchair to other surfaces.

On Monday, February 13, 2023 The Centers for Medicare & Medicaid Services released a press release on the Biden-Harris administration’s efforts to implement section 6101(a) of the Affordable Care Act. The proposed rule would require additional ownership and management information about nursing homes across the United States be disclosed. The Administrations attempts to implement the rule is part of a continued effort by the administration to improve quality of care at nursing homes.

Yesterday the Centers for Medicare & Medicaid Services (CMS) announced next steps describing how the agency will implement the new Medicare Prescription Drug Inflation Rebate Program, including a timeline of key dates. As part of the Inflation Reduction Act (IRA) of 2022 (P.L. 117-169), the Medicare Prescription Drug Inflation Rebate Program requires drug companies to pay a rebate to Medicare if they raise prices for certain drugs faster than the rate of inflation. Based on a 12 month period starting October 1, 2022, drug companies will be required to pay rebates to Medicare for raising prices that outpace inflation on certain Part D drugs.

The Centers for Medicare & Medicaid Services (CMS) recently released seven new resources focused on strengthening the DSW. The online training, Recruiting, Selecting, and Retaining Direct Service Workers to Provide Self-directed Home and Community-Based Services (HCBS), provides guidance and information for people who self-direct, or wish to self-direct, their HCBS, as well as others interested in information on finding, hiring, and retaining direct service workers. You can access all of these resources from CMS’ Direct Care Workforce page and ADvancing States' HCBS Clearinghouse.

In light of the Biden-Harris Administration announcing their intent to end the public health emergency (PHE), CMS has created a suite of updated resources to provide guidance around the unwinding. All tools can be found on the CMS Emergencies Page of their website. Guidance includes but is not limited to, a fact sheet for information about PHE waiver flexibilities, Acute Hospital at Home information, and the CMS 1135 Waiver/ Flexibility request inquiry form. The CMS Emergencies Page will be updated continuously as the end of the PHE nears. CMS encourages regular visits to the page for the most up to date information regarding PHE unwinding.