Today, the Centers for Medicare & Medicaid Services (CMS) is providing an at-a-glance summary of news from around the agency.
CMS Approves South Dakota’s Medicaid Coverage Expansion to New Adult Group Effective July 1, 2023
May 23: CMS approved a state plan amendment (SPA) allowing South Dakota to expand Medicaid coverage to adults with incomes up to 133% of the federal poverty level beginning July 1, 2023. Under the Affordable Care Act, states have the authority to expand Medicaid coverage, and with the addition of South Dakota, 39 states plus the District of Columbia have done so. Related document can be found here by filtering on “South Dakota.”
CMS Announces Temporary Gap in Competitive Bidding Program for Durable Medical Equipment to Establish Better Prices for Beneficiaries in Need of Prosthetics, Orthotics, and Supplies
May 25: CMS announced a temporary gap in the Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) Competitive Bidding Program (CBP) starting on January 1, 2024. During this time, CMS aims to strengthen the program and establish sustainable prices for durable medical equipment, prosthetics, orthotics, and supplies through rulemaking to save money for people with Medicare and taxpayers while ensuring people have access to quality equipment in the Medicare program. CMS will resume the next round of bidding after receiving public comment through rulemaking. During the temporary gap, Medicare payment will generally continue at current payment allowances established through competitive bidding, adjusted by inflation, and following payment provisions in statute and regulation. Information can be found in this fact sheet.
CMS Innovation Center Issues Latest Evaluation Reports on Several Care-Delivery Models
May 30: CMS released the Second Annual evaluation report on the Maternal Opioid Misuse (MOM) Model. Aligned with the administration’s focus on maternal care and advancing health equity, the MOM Model is a patient-centered service delivery model aiming to improve the quality of care for pregnant and postpartum Medicaid patients with opioid use disorder (OUD) and their infants. The Innovation Center launched the MOM Model in eight states (Colorado, Indiana, Maine, Maryland, New Hampshire, Tennessee, Texas, and West Virginia) with care delivery partners. The qualitative analysis found that states have not fundamentally altered existing Medicaid benefits but that care sites have implemented equity and anti-stigma initiatives and have added new services such as peer recovery coaches. Enrollees report positive care experiences. Awardees encounter challenges across many areas of implementation, particularly enrollment, which remains low. Here are links to the Findings at a Glance and the full report.
May 31: CMS released the Fifth Evaluation Report of the Oncology Care Model (OCM). The OCM aimed to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. The report focuses on the model’s impacts on Medicare payments, utilization, and quality outcomes based on quantitative and qualitative analyses through the first nine performance periods, from July 2016 to January 2021. The report found that the OCM led to reductions in total episode payments, primarily through improved use of high-value supportive care drugs among higher-risk cancer types. These reductions were offset by increased performance-based payments and monthly enhanced oncology service payments, such that net losses decreased over time but did not result in net savings. Here are links to the Findings at a Glance, Executive Summary, and the full report.
May 31: CMS released the Fifth Evaluation Report of the Comprehensive Care for Joint Replacement (CJR) Model. The CJR model was launched in April 2016 to test whether an episode-based payment model for lower extremity joint replacement can lower payments while maintaining or improving quality. The report focuses on the model’s impacts on Medicare payments, utilization, and quality outcomes based on quantitative and qualitative analyses through the first five performance years, beginning April 1, 2016 and ending September 30, 2021. The report found that hospitals participating in the model achieved a statistically significant reduction in average episode payments due to reductions in institutional post-acute care use. Quality of care, as measured by the unplanned readmission rate, emergency department use, mortality, and the elective lower extremity joint replacement complication rate, improved or was maintained under the CJR model. Here are links to the Findings at a Glance, Executive Summary, and the full report.
CMS Notifies Rhode Island of its 2023 Final Pass-Through Funding
May 30: CMS notified Rhode Island that it will receive $10,758,473 in section 1332 waiver federal pass-through funding for the 2023 plan year. Section 1332 waivers permit states to pursue innovative strategies for providing residents with high-quality, affordable health insurance while retaining the basic protections of the Affordable Care Act. If a state waiver plan reduces the amount of premium tax credit (PTC) or small business health care tax credit that individuals and employers in the state would otherwise receive without the waiver, the savings are paid to the state through federal pass-through funding. The funding notice for Rhode Island can be found here.
COVID-19 Vaccination and Education Must Remain Available to Staff & Residents of Long- Term Care Facilities as Federal Requirements Sunset
May 31: Following the end of the COVID-19 public health emergency (PHE), CMS issued a final rule that sunsets federal requirements for health care staff to be vaccinated. CMS will continue to require Skilled Nursing, Long-Term Care, and Intermediate Care Facilities for Individuals with Intellectual Disabilities to provide COVID-19 educational information and vaccines to their residents, clients, and staff. More information can be found here. Because vaccination is the best protection against COVID-19, CMS will continue encouraging everyone to stay current on their vaccines.
CMS Releases Information & Resources Focusing on Improving Health Care for LGBTQI+ Individuals
June 1: In recognition of Pride Month and as part of CMS’ commitment to improving health care access, outcomes, and experiences for LGBTQI+ individuals, the agency posted a variety of resources, information, and learning tools for providers and partners. Information includes data snapshots, Coverage to Care information, and additional HHS resources for people working with the LGBTQI+ community. Information can be found here.
Other Recent Releases:
Biden-Harris Administration Announces Proposal to Advance Prescription Drug Transparency in Medicaid
CMS Announces Plan to Ensure Availity of New Alzheimer’s Drugs
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CMS, an agency within the U.S. Department of Health and Human Services, serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. The agency protects public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and the Health Insurance Marketplace.
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