Fact Sheets

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...

Justice in Aging recently released a fact sheet on the annual open enrollment periods (OEP) for Medicare and the Marketplace for the 2024 plan year and highlights issues that are of particular relevance to assisting low-income older adults. Medicare open enrollment is currently underway and ends December 7th. Low-income individuals may be eligible for financial assistance with Medicare costs through the Medicare Savings Program and Low-Income Subsidy/Extra Help. Older adults who are not eligible for Medicare and do not have other health insurance can use the annual fall OEP to enroll in or change 2024 coverage through the Affordable Care Act’s Health Insurance Marketplaces...

The LEAD Center recently published a fact sheet introducing employers to the Good Jobs Initiative and the Good Jobs Principles, highlighting their potential impact on promoting competitive integrated employment for individuals with disabilities. Additionally, the fact sheet offers resources to assist employers in the hiring, accommodation, and retention of people with disabilities.

On November 1, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update final rule, which updates Medicare payment policies and rates for Home Health Agencies (HHAs). This rule includes routine updates to the Medicare Home Health PPS payment rates for CY 2024 in accordance with existing statutory and regulatory requirements. CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023....

On October 27, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment rates and policies 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 (CY) 2024, CMS is increasing the ESRD PPS base rate to $271.02 and increasing total payments to ESRD facilities by approximately 2.1%. Additionally, the final rule discusses responses to the requests for information issued in the proposed rule to inform potential future rulemaking regarding updates to the low-volume payment adjustment methodology and the possible creation of a new payment adjustment that would increase payment...

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....

National Consumer Voice's (NCV) new fact sheet, “Advocating for Rights and Better Care in Nursing Homes,” provides tips for residents and families to advocate for change in their nursing facilities and advocacy strategies for impacting long-term care policy. This fact sheet offers practical steps for residents to address concerns within their nursing facilities, including having discussions with nursing home staff, participating in care plan meetings, utilizing the facility's grievance process, engaging with resident or family councils, and more. Additionally, the resource outlines advocacy strategies to impact long-term care policy, such as sharing personal stories, contacting elected officials, reaching out to the media, and participating

The Integrated Care Resource Center (ICRC) recently released a resource titled, “Tips for States on Incorporating D-SNPs into Medicaid Quality Improvement Activities”. This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities. D-SNPs are a type of Medicare Advantage plan that enrolls individuals who are entitled to both Medicare and medical assistance from a state plan under Medicaid. States cover some Medicare costs, depending on the state and the individual’s..

The proposed Access Rule from the Centers for Medicare & Medicaid (CMS) is a transformational shift that would change requirements in place since 2014. WellSky has recently released a tip sheet providing a framework to plan for the Access Rule and its implications. By starting to plan early, funding may still be available from the American Rescue Plan Act (ARPA). Waiver programs can also learn much from the history of VBP in healthcare, which is briefly described in this tip sheet. This resource will help attendees understand: 1. What is the Access Rule 2. How the Access Rule may lead to value-based payment (VBP) 3. What value-based strategies should you consider

On September 1, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to establish staffing requirements, including national minimum nurse staffing standards, for nursing facilities. Nursing facilities participating in Medicare and Medicaid would be required to: provide residents with a minimum of 0.55 hours of care from a registered nurse (RN) per resident per day (hours per resident day or HPRD) and 2.45 hours of care from a nurse aide (NA) per resident per day; have a registered nurse onsite 24 hours per day, seven days per week to provide direct resident care; and complete facility assessments on staffing needs. CMS proposes that implementation of the final requirements will occur in three phases over a three-year...