Fact Sheets

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...

This week the Federal Communications Commission (FCC) announced more than 20 million households have enrolled in the agency’s Affordable Connectivity Program (ACP). With the Affordable Connectivity Program (ACP), the FCC is now helping households across the country connect to the internet and save on their monthly bill. In order to reach today’s enrollment milestone, the FCC heavily engaged local, state and federal organizations to serve as ACP outreach and awareness-raising partners. The FCC has committed over $72 million in grants at the state and local level, with 228 ACP Outreach Grants issued to trusted state, local, and Tribal governments and community partners. If you or someone you know is seeking affordable internet connectivity

The CMS fact sheet notes the one-year anniversary of the Inflation Reduction Act (IRA) of 2022 and describes provisions in the law affecting Medicare and Marketplace plans, including a summary of milestones CMS has met. A list of public education tools to help people with Medicare and those who assist them in understanding the changes under the IRA are included.

CMS recently issued several final rules on payment rates and policies fiscal year for (FY) 2024. 1. FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1785-F and CMS-1788-F Fact Sheet 2. Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System Final Rule - CMS-1779-F 3. Fiscal Year 2024 Hospice Payment Rate Update Final Rule (CMS-1787-F) 4. Fiscal Year 2024 Medicare Inpatient Psychiatric Facility Prospective Payment System and Quality Reporting Final Rule 5. Fiscal Year 2024 Inpatient Rehabilitation Facility Prospective Payment System Final Rule (CMS-1781-F)

The ASPE recently issued fact sheets for each state and the District of Columbia highlighting health care cost savings as a result of the Inflation Reduction Act (IRA) and the Affordable Care Act (ACA). Savings from Medicare Part D out-of-pocket costs, insulin, vaccines, and Marketplace premiums, and the latest enrollment data for Medicare, Medicaid and Marketplace are featured.

AARP recently released a fact sheet describing the prevalence of food insecurity among adults aged 50 and older in 2021. The fact sheet reveals that over 9 million Americans in this age group (approximately eight percent) experienced limited or uncertain access to nutritious food. Moreover, this fact sheet highlights the impact of food insecurity on the health of older adults, showing a higher prevalence of health conditions like diabetes, high blood pressure, congestive heart failure, asthma, and depression among food-insecure individuals. The report also explores important variations in food insecurity based on factors such as age, race, ethnicity, income, and educational attainment.

CMS projects the calendar year 2024 average total monthly premium for Medicare Part D prescription drug coverage to be $55.40; a decrease of 1.8 percent from 2023. The average total Part D premium is the sum of the average basic premium and the average supplemental premium for plans with enhanced coverage. CMS reports that the projected decrease in the average total Part D premium is due to a limit in the growth of the base beneficiary premium to an annual six percent increase and other changes to the Part D benefit in 2024 as specified by the Inflation Reduction Act. Additionally, in 2024 CMS’ Part D pharmacy price concessions policy is expected to reduce beneficiary out-of-pocket costs by requiring Part D plans to apply all price...

This week, CMS announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through care coordination and management, caregiver support, and respite services. Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. The intended beneficiary population is community-dwelling Medicare fee-for-service beneficiaries, including beneficiaries dually eligible for Medicare...

On July 7, The U.S. Department of Health and Human Services (HHS) announced actions to protect consumers from junk health plans, surprise medical bills, and excess costs that lead to medical debt. HHS also released a new report projecting that nearly 19 million older adults and people with disabilities with Medicare will save on average $400 per year on prescription drug costs when the $2,000 out-of-pocket prescription drug spending cap from the Inflation Reduction Act (IRA) goes into effect in 2025...