Announcement/Press release

The KFF recently published two analyses on demographics and program enrollment and spending of Medicare and Medicaid dually eligible beneficiaries or dual eligibles. The article, “A Profile of Medicare-Medicaid Enrollees”, analyzes the demographic, socioeconomic, and health characteristics of dual eligibles using data from the 2020 Medicare Current Beneficiary Survey. The second article, “Enrollment and Spending Patterns Among Medicare-Medicaid Enrollees (Dual Eligibles)”, examines national and state-level data on enrollment and spending for Medicare-Medicaid enrollees. The authors used data from the 2019 and 2020 Medicare Beneficiary Summary Files and the 2019 Transformed Medicaid Statistical Information System for this analysis.

The National Conference of State Legislatures recently released an article exploring different steps that states are taking to address the rapidly aging population and how to keep that population in their homes longer. The article looks at approaches from across the country exploring food security, financial support, transportation, housing, the direct care workforce, social isolation prevention, and more.

The Federal Communications Commission released guidance earlier this week permitting states and managed care plans to make calls, or robocalls, and send text messages under certain circumstances without violating federal law. The FCC’s ruling comes in response to a letter from the Secretary of the U.S. Department of Health and Human Services requesting an exception to the federal Telephone Consumer Protection Law as states reach out to enrollees to raise awareness of forthcoming Medicaid eligibility redeterminations. The federal guidance clarifies how states working with local government agencies and managed care companies may, under certain circumstances, make robo calls or send autodialed text messages

There are several changes that may affect SNAP household’s benefit amounts over the coming months. The temporary boost to SNAP benefits put in place during the COVID-19 pandemic, known as emergency allotments, will end nationwide after the February 2023 issuance. In addition, households that receive SNAP and Social Security benefits will see a decrease in their SNAP benefits because of the significant cost of living increase to Social Security benefits that took effect on Jan. 1, 2023.

The FDA recently granted accelerated approval for the drug Leqembi, a medication intended to slow the progression of Alzheimer’s disease. Leqembi, the brand name for lecanemab, is the second Alzheimer’s therapy for individuals with mild cognitive impairment. Lequembi targets the protein amyloid and can be prescribed to patients in early to mid-stages of Alzheimer’s disease. Eisai, the manufacturer of Leqembi, reports that the drug will be available by January 23, 2023 and estimates the cost of the biweekly infusion to be $26,500 annually. Medicare coverage of Leqembi and other drugs like it, such as Aduhelm, that have accelerated FDA approval are limited to beneficiaries enrolled in certain clinical trials.

On December 15, 2022 U.S. Senate Special Committe on Aging held a hearing to recognize the impact of federal nutrition assistance programs in reducing hunger among older adults. At the hearing, the Committee released a bipartisan report, entitled “Recognizing 50 Years of the Nation’s First Nutrition Program for Older Adults.” The report celebrates the role of the Older Americans Act Nutrition Program in reducing hunger, promoting health, and enhancing the wellbeing and quality of life of older adults. The Committee also released state-by-state fact sheets highlighting the impact of the Older Americans Act Nutrition Program in each Committee member’s state.

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, CMS issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. CMS proposes to modernize the health care system by requiring certain payers to implement an electronic prior authorization process, shorten the time frames for certain payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent.

On Friday, November 11, 2022 HHS announced that it will again extend the COVID-19 Public Health Emergency (PHE). Based on commitments to provide at least 60 days’ notice prior to allowing the PHE to lapse, HHS had until Saturday, November 12, to provide states with notice that the PHE would either be extended or end in January. This means that unwinding protocol will not yet begin, and that the PHE policies such as Medicaid FMAP increases; continuous eligibility; and the 1135, Appendix K, and Emergency SPAs will remain in effect.

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.