Centers for Medicare and Medicaid Services (CMS)

On September 26th, The Biden-Harris Administration released guidance on health coverage requirements for children and youth enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The guidance serves as support for states in ensuring children with Medicaid and CHIP coverage receive the full range of health care services they require. Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements provide comprehensive health coverage for children and youth. The guidance reinforces the EPSDT requirements and includes strategies and best practices for states in implementing the requirements. Included is an explanation for statutory and regulatory EPSDT requirements. Read CMS's release to learn more.

On Friday, April 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of January 2023, over 65.5 million people are enrolled in Medicare; more than 33.9 million are enrolled in fee-for-service Medicare and nearly 31.6 have a Medicare Advantage plan. Over 93 million enrollees have Medicaid and CHIP; more than 85.9 million individuals have Medicaid and nearly 7.1 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

CMS made publicly available detailed information on the ownership of over 6,000 hospices and 11,000 home health agencies that are Medicare-certified. Data elements include: organization name, type, practice location addresses, National Provider Identifier (NPI), CMS Certification Number (CCN); detailed information about each owner such as whether it is an organization or an individual and whether it is a direct owner or indirect owner; and a numerical associate ID for each owner to enable linkage to the enrollment file.

On March 31st, the Board of Trustees for Medicare released their most recent report to Congress on the financial operations and actuarial status of Medicare. The Trustees Report describes past and estimated future financial operations of the Hospital Insurance (HI) (Part A) and Supplementary Medical Insurance (SMI) (Part B and prescription drug coverage) trust funds. According to the report, the Medicare HI trust fund will have funds to pay for Part A benefits until 2031, three years longer than what was reported last year due to higher projected HI income and lower expenditures. However, the Trustees project deficits in the HI trust fund starting in 2025.

the MMCO submitted its FY 2022 Medicare-Medicaid Coordination Office Report to Congress, as required by statute. Federal statute established the Federal Coordinated Health Care Office or MMCO within CMS to improve the coordination between the federal government and states to enhance access to quality services for individuals dually eligible for both Medicare and Medicaid benefits. The report describes MMCO’s activities to better serve dually eligible individuals in 2022 and contains three legislative recommendations, which were proposed in the Presidents Fiscal Year (FY) 2024 Budget.

CMS issued a proposed rule (CMS-1787-P) that would update Medicare hospice payments and the aggregate cap amount for FY 2024 in accordance with existing statutory and regulatory requirements. This rule includes information on hospice utilization trends and solicits comments regarding information related to the provision of higher levels of hospice care, spending patterns for non-hospice services provided during the election of the hospice benefit, ownership transparency, equipping patients and caregivers with information to inform hospice election decision-making selection, and ways to examine health equity under the hospice benefit. This rule also proposes conforming regulations text changes related to the expiration of the COVID-19 PHE.

On Wednesday, April 5th, CMS issued a final rule that revises the Medicare Advantage (MA or Part C), Medicare Prescription Drug Benefit (Part D), Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, and network adequacy. Additionally, the final rule also makes permanent the Limited Income Newly Eligible Transition (LI NET) Program and expands eligibility for the full low-income subsidy benefit to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria.

CMS released the Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for MA plans of 3.32% from 2023 to 2024, which is approximately a $13.8 billion increase in MA payments for next year. The Rate Announcement finalizes updates to MA payment growth rates and changes to the MA and Part D payment methodologies. These include technical and clinical updates to the MA risk adjustment model to keep it up to date and improve payment accuracy.

On Tuesday, March 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of December 2022, over 65.2 million people are enrolled in Medicare; more than 35 million are enrolled in fee-for-service Medicare and over 30.2 have a Medicare Advantage plan. Over 91.3 million enrollees have Medicaid and CHIP; more than 84.3 million individuals have Medicaid and over seven million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

On Thursday, October 21, 2021 CMS launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).