CMS Round Up
CMS Roundup (May. 31, 2024)
Today, the Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.
CMS Approves a Five-Year Extension of Delaware’s Diamond State Health Plan Demonstration
May 17: CMS approved a five-year extension of the "Delaware Diamond State Health Plan (DSHP) Section 1115 Demonstration.” This approval will sunset a waiver of retroactive eligibility on January 1, 2025, and enable the state to provide three months of retroactive eligibility for all eligible Medicaid enrollees. The approval also adds three new benefits, which allow the state to: (1) Expand the state-funded pilot to provide home-delivered food and eighty diapers per week to postpartum members and babies, which will reach low-income postpartum members with disproportionately high rates of food insecurity and inequitable adverse maternal and birth outcomes; (2) Provide contingency management services for pregnant and post-partum Medicaid members with stimulant use disorder or opioid use disorder; and (3) Include children's dental services in the demonstration’s managed care delivery system.
CMS Approves Three New Benefits Through Amendment to Tennessee's “TennCare III” Medicaid Section 1115 Demonstration
May 17: CMS approved an amendment to Tennessee's TennCare III Medicaid section 1115 demonstration. This amendment adds three new benefits: (1) Expansion of Medicaid eligibility for parents and caretaker relatives of dependent children up to 100 percent of the federal poverty level (FPL). By increasing Medicaid eligibility for up to 100 percent of the FPL, Tennessee will now provide Medicaid coverage for this group up to the FPL threshold at which individuals become eligible for federally subsidized premium assistance for health coverage available on the Federally Facilitated Marketplace (FFM). Closing the coverage gap between eligibility for the two health insurance programs helps to lower the uninsured rate and increase access to medically necessary health care. In addition, the amendment includes (2) Approval of a new benefit to provide coverage of 100 diapers per month per child, for families with children under the age of two; and (3) Authority for the state to make several home- and community-based services (HCBS) enhancements, with a focus on employment services and supports, to promote increased independence for individuals with disabilities in their homes, communities, and workplaces.
CMS Releases Updated Health Equity Fact Sheet Outlining Goals and How Health Equity Actions Align with CMS’ Six Strategic Pillars
May 24: CMS released an updated Health Equity Fact Sheet on the Health Equity page and the Strategic Plan page/strategic pillars page. CMS infuses health equity — the ability for everyone to obtain their optimal health — in everything it does. CMS programs provide health coverage to nearly one in two Americans and are critical to helping to ensure that individuals and families have access to quality health care. CMS’ goal is to ensure that every person can access the care they seek at an affordable cost, aim to eliminate avoidable differences in health outcomes, and to provide the care and support people need to thrive. Health equity is foundational to the CMS Strategic Plan and addressed within each of our strategic pillars. The CMS health equity strategy builds on the Biden-Harris Administration’s commitment to advancing racial equity and support for underserved communities through the federal government, as described in President Biden’s Executive Orders 13985 and 14091. The Health Equity fact sheet outlines CMS’ Health Equity goals and how CMS’ health equity actions align with our six strategic pillars.
CMS Announces Updates to Include Marriage and Family Therapists and Mental Health Counselors for Hospice, Rural Health Clinics, and Federally Qualified Health Centers
May 28: CMS announced in a memo to State Survey Directors updates to the Hospice Conditions of Participation (CoPs), the Rural Health Clinic (RHC) Conditions for Certification (CfCs), and the Federally Qualified Health Center (FQHC) Conditions for Coverage (CfCs) to implement provisions included in the Consolidated Appropriations Act (CAA), 2023. The hospice CoPs’ update requires the hospice interdisciplinary group to include at least one social worker, marriage, and family therapist (MFT), or mental health counselor (MHC). Additionally, the RHC and FQHC CfCs update the staffing and personnel requirements to include MFTs and MHCs as part of the collaborative team approach to providing services. The RHC and FQHC CfC definitions were updated to include MFTs and MHCs as recognized staff alongside other health care professionals who are already eligible to provide services, and the definition of “nurse practitioner” was revised to align with current standards of professional practice.
CMS Releases Infographic on Health Care Utilization of Pregnancy-Related Care in Medicaid and the Children’s Health Insurance Program
May 28: CMS released an infographic overview of people who are Medicaid and Children's Health Insurance Program (CHIP) recipients seeking pregnancy-related care and those with a recent live birth. More than one out of every four recipients of Medicaid and CHIP are individuals in their reproductive years (ages 15-49), and Medicaid finances about 41 percent of all births in the United States. CMS is uniquely positioned to improve the quality of maternity care, improve perinatal outcomes, and reduce disparities through quality improvement and measurement and supporting value-based care. This infographic provides an overview of the demographics, access to care, health status, health outcomes, risk factors, and health care utilization among this population.
CMS Releases Fifth Annual Report on Evaluation of Bundled Payments for Care Improvement Advanced Model
May 29: CMS released the fifth annual report on the evaluation of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. The BPCI Advanced Model tests whether holding participants financially accountable for the cost and quality of health care services during an episode can reduce Medicare spending while maintaining or improving quality of care. This is the first report assessing the model after significant changes were implemented in Model Year 4 (2021) to improve the likelihood of achieving Medicare program savings and to expand care redesign activities to more patients. The report found that the BPCI Advanced Model resulted in net savings to Medicare in 2021, estimated to be $465 million, offsetting losses in earlier model years, and had varied quality results.
CMS Announces a Request for Applications for Participants in the Accountable Care Organizations Primary Care Flex Model (ACO PC Flex Model)
May 30: CMS announced a Request for Applications (RFA) for participation in the Accountable Care Organizations (ACO) Primary Care (PC) Flex Model. The ACO PC Flex Model is a new, voluntary payment model that will focus on advanced primary care delivery in the Medicare Shared Savings Program (Shared Savings Program). The model will launch on January 1, 2025, and run for five years. CMS has made improving primary care a cornerstone of its strategy for improving access to high-quality, person-centered care. The ACO PC Flex Model is the first model to provide prospective, population-based payments based on the average primary care spending of the region in which an ACO operates, as opposed to the historical experience of the ACO. The model is being tested and requires participation within the Shared Savings Program to provide a streamlined pathway to adopt lessons learned from the model and to attract new ACOs to the program. The deadline to submit an application to the Shared Savings Program is June 17, 2024. The ACO PC Flex Model increases funding for primary care delivered by low-revenue ACOs in the Shared Savings Program so that they can provide advanced primary care, improve people’s experience and outcomes, and save on unnecessary health care spending. Interested ACOs must first apply to the Shared Savings Program. An ACO PC Flex Application Overview Webinar will be held June 6, 2024, 2:00 - 3:30 pm ET. Register to attend the webinar here.
CMS Releases Diabetes Impact Report Summarizing Advances Made in Improving Diabetes Care
May 30: CMS released a CMS Diabetes Strategy — Impact Report on CMS’ Office of Minority Health (OMH) website, updating the diabetes work happening at CMS. This resource summarizes the advances made in improving diabetes care in Medicare in calendar year (CY) 2023, including prevention, screening, and diagnosis, as well as access to treatment, services, and support. The report was also made available at the CMS Health Equity Conference, which occurred this week.
CMS Announces the Release of 2022 Quality Payment Program Performance
May 30: CMS announced that the 2022 Quality Payment Program (QPP) performance information has been released for doctors, clinicians, groups, virtual groups, and Accountable Care Organizations (ACOs) to clinician and group profile pages on the Medicare.gov compare tool and in the Provider Data Catalog (PDC). CMS is required to report Merit-based Incentive Payment System (MIPS) eligible clinicians’ final scores and performances under each MIPS performance category, names of eligible clinicians in Advanced Alternative Payment Models (APMs) and, to the extent feasible, the names and performance of such Advanced APMs. Performance information for doctors and clinicians is displayed using measure-level star ratings, percent performance scores, and checkmarks. Medicare patients and caregivers can use the compare tool on Medicare.gov to search for and compare doctors, clinicians, and groups who are enrolled in Medicare. Publicly reporting 2022 QPP performance information helps empower patients to select and access the right care from the right provider. The announcements will also direct doctors and clinicians to the Care Compare: Doctors and Clinicians Initiative page for informational materials about the published performance data.
CMS Announces a Request for Applications for the Second Cohort of Individuals for the Enhancing Oncology Model
May 30: CMS announced a Request For Applications (RFA) for a second cohort of participants in the Enhancing Oncology Model (EOM) that will begin on July 1, 2025. EOM is a voluntary payment model intended to transform care for cancer patients. EOM aims to improve care coordination, quality, and health outcomes for patients while also holding oncology practices accountable for total costs of care to make cancer care more affordable, equitable, and accessible for patients and Medicare.CMS also made notable changes to the model, including extending the model by two years, making a higher monthly payment for enhanced services, and raising the threshold for the point at which participants are required to pay back CMS for costs related to their patients’ care. The RFA with detailed information about participation and the design of the EOM is available on the EOM website beginning July 1, 2024. The application portal for interested applicants will be open from July 1, 2024, to September 16, 2024. Further details on how to apply are forthcoming.
CMS Releases the Final Evaluation Report for the Oncology Care Model
May 30: CMS released the Evaluation of the Oncology Care Model Final Report on cms.gov. In February 2015, CMS invited oncology physician group practices to participate in the Oncology Care Model (OCM), an alternative payment model (APM) based on six-month episodes for cancer care for people with Fee-for-Service (FFS) Medicare undergoing chemotherapy treatment. The six-year OCM began on July 1, 2016, and operated for 11 consecutive six-month performance periods (PPs). The last episodes ended on June 30, 2022. OCM was designed to improve the costs and quality of oncology care through payments for monthly enhanced oncology services and financial performance. OCM resulted in lower health care expenditures during the six-month episode of care, but these reductions were not sufficient to fully offset model payments. While practices reported substantial efforts to transform care, these changes did not always lead to improvement in clinical and quality outcomes relative to non-participating practices. Included with the evaluation report is a Patient Perspectives Report, written for a patient audience that summarizes findings from patient interviews about their experiences with cancer care.
CMS Announces Extension of State Reporting of Medicaid Renewals Outcomes
May 30: CMS released a State Health Official (SHO) letter announcing that it is extending state reporting of certain Medicaid and Children’s Health Insurance Program (CHIP) metrics that states first started reporting during the return to full Medicaid and CHIP renewals, also known as “unwinding.” As described in the SHO, state reporting on renewal outcomes will continue after the Consolidated Appropriations Act, 2023, requirements end on June 30, 2024. CMS will continue reporting state and national data publicly to continue providing transparency into Medicaid and CHIP eligibility and enrollment processes as well as individuals’ ability to renew their coverage.
Other Recent Releases:
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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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