CMS

On Friday, October 28, 2022, CMS issued a final rule that simplifies Medicare enrollment and eligibility rules, extends coverage of immunosuppressive drugs for certain beneficiaries, and finalizes changes to improve state payment of Medicare premiums. Beginning January 1, 2023, individuals applying for Medicare premium Part A and Part B during the last three months of their Initial Enrollment Period or during the General Enrollment Period will have their coverage start the month after they enroll, reducing delays in coverage. The rule also allows certain Medicare special enrollment periods (SEPs) to permit Medicare Part B coverage without a late enrollment penalty.

This week CMS issued a final rule for the Calendar Year 2023 Physician Fee Schedule which includes updates and policy changes for Medicare payments and other Part B issues. Some of the changes include expanding access to behavioral health services by allowing certain health practitioners to provide and manage a beneficiary’s behavioral health needs; extending several telehealth services that are temporarily available for the COVID-19 public health emergency at least through calendar year 2023; and clarifying payment for dental examinations and treatments in more circumstances, such as prior to organ transplants and certain cardiac procedures beginning in calendar year 2023.

On September 26, 2022, in an effort to improve nursing home transparency, safety, quality, and accountability, the U.S. Department of Health and Human Services made additional data publicly available that provides information about the ownership of all Medicare-certified nursing homes. This data will give state licensing officials, state and federal law enforcement, researchers, and the public the ability to identify common owners of nursing homes across multiple locations. This data can help to identify the performance of facilities under common ownership, including owners affiliated with multiple nursing homes with a record of poor performance.

CMS recently announced the 2023 Medicare costs, including premiums, deductibles, and coinsurance amounts. The standard monthly Part B premium will decrease three percent or $5.20 – the first time in a decade the cost was lowered. CMS attributes the decrease in the Part B premium to lower spending on the Alzheimer drug, Aduhelm, and other Part B items and services.

The U.S. Department of Health and Human Services, through CMS, awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services through Medicaid’s Money Follows the Person (MFP) demonstration program. With these awards, 41 states and territories across the country will now participate in MFP. Awards of up to $5 million have been granted to Illinois, Kansas, and New Hampshire, as well as for American Samoa and Puerto Rico. This is the first time MFP grants have been made available to territories. These awards will support the early planning phase for their MFP programs.

On Monday, August 22, 2022 CMS released the Money Follows the Person (MFP): Updated State Transitions annual report for calendar years 2017 to 2020. The MFP demonstration, established by Congress through the Deficit Reduction Act of 2005, enables state Medicaid programs to help Medicaid beneficiaries who live in institutions transition into the community, and gives people with disabilities and older adults more choice in deciding where to live and to receive long-term services and supports. From the time transitions began in 2008 to the end of 2020, states had transitioned 107,128 people to community living through MFP. The brief shows how MFP transitions varied by state and target population over time.

Late yesterday CMS released a State Medicaid Director Letter (SMDL 22-003) providing guidance for the first-ever HCBS Quality Measure Set, the first of two planned guidance documents from CMS. The HCBS Quality Measure Set is included in the SMD, starting on page 14. The list of measures includes the NQF number (if applicable), measure steward, and data collection method, as well as information on whether each measure addresses section 1915(c) waiver assurances and/or can be used to assess access, LTSS rebalancing, and/or community integration and HCBS settings requirements.

On Monday, June 27, 2022 the Biden Administration announced a new model aimed at improving cancer care for Medicare patients and lowering health care costs. CMS’ Center for Medicare and Medicaid Innovation designed the Enhancing Oncology Model (EOM) to test how to improve health care providers’ ability to deliver patient-centered care and consider patients’ unique needs. The model will focus on supporting patients, caregivers, and survivors, while addressing inequities and providing patients with treatments that address their individual needs.

On Monday, June 13, 2022 CMS released the 2020 Medicaid Managed Care Enrollment and Program Characteristics and Data Tables. This national data is broken down by program, population, and individual state. The enrollment data provides a snapshot of Medicaid managed care enrollment as of July 1, 2020.

CMS has released a new data highlight on Consistency of Preventive Care Among Medicare Beneficiaries. The data highlight uses data from the Medicare Current Beneficiary Survey to analyze adherence to flu shot and breast cancer screening guidelines among Medicare beneficiaries between 2016 and 2019. The data highlight breaks this information down to look at the rates among different demographic groups.