On October 17, 2023, CMS held their quarterly National Stakeholder Call to provide updates on recent accomplishments and how their initiatives advance CMS’ Strategic Plan. Administrator Chiquita Brooks-LaSure, kicked off the call by announcing the start of Medicare open-enrollment and how the entire agency is focused on educating beneficiaries on all 2024 benefits and encouraging people to renew their vaccinations which are available at no additional cost. Brooks-LaSure also revealed how for the first-time, high-cost prescription drugs will have a “catastrophic limit” in 2024. Dr. Meena Seshamani, the Director for the Center for Medicare explained that in 2024, Part D enrollees who reach what CMS calls “catastrophic fees” (the maximum threshold for paying out of pocket) will no longer have to pay a co-pay or out of pocket costs at the pharmacy. Dr. Seshamani also shared that beneficiaries taking insulin will not have to pay more than $35 for each supply of insulin products covered under part D and that people will not have to pay nothing out of pocket for recommended vaccines like shingles. CMS also spoke about the drugs selected for the Medicare Drug Price Negotiation program. CMS will have a patient-focused listening session on 11/15 for each selected drug to provide an opportunity for patients, beneficiaries, caregivers, and patient organizations can share relevant input for these selected drugs. Lastly, Dr. Seshamani shared that ACOs participating in the Medicare Shared Savings Program (MSSP) saved Medicare $1.8 billion in 2022. This is the 6th consecutive year that the program has generated overall savings, and the 2nd highest annual savings accrued for Medicare since the program’s inception.
The Deputy Administrator and Director for the Center for Medicaid and CHIP (CMCS), Dan Tsai, explained that CMCS’s highest priority is Medicaid renewals and redetermination and partnering with other teams across CMS to maintain Medicaid coverage and enrollment after the end of the public health emergency. Close to 90 million people are still enrolled in Medicaid and CHIP which is about 20 million people above pre-pandemic numbers. CMCS has approved over 300 waivers and policy options to make the CHIP and Medicaid renewal process more streamlined including allowing children enrolled in SNAP to remain enrolled in CHIP. Additionally, a federal statute now requires states to have children continuously enrolled in CHIP for 12 months starting in 2024. Tsai also announced that North Carolina is the most recent state to expand Medicaid.
Arrah Tabe-Bedward, the Deputy Director of the CMS Innovation Center (CMMI), provided updates on the Guiding an Improved Dementia Experience (GUIDE) and States Advancing All-Payer Health Equity Approaches and Development (AHEAD) models. The GUIDE model was released on July 31st and will seek to address challenges with three goals: improve quality of life, reduce strain on unpaid caregivers, and help people to remain in homes by preventing long-term nursing placement. Request for applications open in the fall of 2023 and the program will launch on July 1, 2024. And on September 5th, CMMI announced the states for the AHEAD model where states commit to set targets for improving Medicare fee for service in all-payer cost growth in primary care and statewide quality/equity. Tabe-Bedward also announced that over the summer, CMMI recently accepted public comments to gather input on a future episode-based payment model and are currently reviewing them.
Dr. Dora Hughes who is the Chief Medical Officer at CMS and Director of the Center for Clinical Standards and Quality (CCSQ) also provided a few updates on current initiatives. On September 4th, CMS released a proposed rule to hold nursing homes accountable to provide safe and high-quality care. They took a multifaceted approach to inform this rule including conducting staffing studies, hosting listening sessions, and analyzing survey data. The proposed rule consists of three core staffing proposals: (1) minimum nursing standards for registered nurses and nursing aides, (2) a requirement to have a registered nurse on site 24 hours a day, seven days a week, and (3) updates to the existing facility assessing requirements. Dr. Hughes went on to share that CCSQ announced an advanced procedural notice highlighting a new Medicare coverage pathway called Transitional Coverage for Emerging Type Pathways or TCET. It is intended to facilitate early, predictable and safe access to new technologies. It will also reduce uncertainty about coverage by evaluating the potential benefits and harms of technologies early. And lastly, it will encourage evidence development if gaps exist. TCET uses current national coverage determination and coverage with evidence development processes to expedite Medicare coverage of certain breakthrough devices. CMS also issued proposed guidance to review current thinking on health outcomes with priority on therapeutic areas. These documents offer insight to how CMS reviews clinical evidence and gives transparency to coverage with evidence development.
The Office of Minority Health (OMH) recently released a sickle cell disease action plan which outlines CMS’ efforts to reduce health disparities and improve health outcomes. The plan’s goals are to (1) expand coverage and access, (2) improve quality along continuum of care, (3) advance equity and engagement, and (4) examine data and analytics. Dr. Aditi Mallick, acting Director of OMH, reported that the agency recently awarded two grants to support research. The first award, the Minority Research Grant program, goes to three minority serving institutions to support research to examine critical public health disparities. This year’s research focuses on maternal health and reentry of incarcerated individuals. The second award, Health Equity Data program, goes to recipients to receive funding to access CMS virtual data to research focused on minority health. Dr. Mallick concluded OMH updates with announcing their partnership with CMS’ Office of Communication advance language access and increase awareness about Medicaid renewals.
Kerry Branick, the deputy director of the Federal Coordinated Health Care Office shared that their office issued a final rule to simplify eligibility for the Medicare Savings Program. Researchers have estimated that only about half of eligible individuals are enrolled in this program. One of the reasons people miss out on enrolling in the Medicare Savings Program is because the eligibility and enrollment process is very complicated even for people who are highly likely or certain to be eligible based on receipt of other program benefits. The final rule eliminates the extra application beneficiaries on SSI would need to submit and most states are required to enroll SSI recipients into the program.
In oral health news, CMS recently launched an oral health initiative focused on expanding access to oral health coverage across all programs. Under the oral health initiatives, they aim to partner with state’s health plans and healthcare providers to improve access to oral health services and leverage the authority to expand care. CMS’ Chief Dental Officer, Dr. Natalia Chambers, announced that they completed a two-year quality improvement learning collaborative to advance oral health prevention and primary care benefiting many Medicaid beneficiaries. As of today, all 50 states and DC have offered dental coverage for Medicaid enrollees who are pregnant or postpartum for 60 days after pregnancy. Additionally, mandatory reporting of oral health related measures will begin in 2024, emphasizing oral exams and application dental sealants. This year’s proposed rule included changes to quantify payment policies for dental services for neck cancer treatments and to expand services linked to cancer related treatments. These changes will ensure access to dental services for Medicaid, Medicare, and marketplace beneficiaries.
CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) along with the Department of Treasury and Labor released a proposed rule on mental health parity. Dr. Ellen Montz, the Deputy Administrator and Director of CCIIO, explained that this proposed rule ensures that mental and behavioral health are provided at parity with physical services at health insurance plans. Additionally, CCIIO continues to release guidance on the implementation of the No Surprises Act. The office is working to establish and refine new independent dispute resolution process to determine appropriate payment amounts for out of network services without involving patients.
Dara Corrigan, the Deputy Administrator and Director for the Center for Program Integrity (CPI), talked about the fraud investigation conducted by CPI on hospice providers. They were interested in hospices in four states (Arizona, California, Nevada, and Texas) where there was an unusually high number of hospices enrolling in the Medicaid hospice benefit. The team analyzed data and conducted a nationwide hospice visit program visiting 6,700 hospices. Nearly 450 of those hospices were considered for deactivation of their Medicare privileges. The goal is to make sure hospices are in the program for the right reasons to provide critical quality end-of-life care to Medicare beneficiaries. Another issue CPI investigated was the integrity of the COVID-19 over-the-counter (OTC) tests that were a part of a Medicare demonstration. The office previously received a high volume of complaints about these tests regarding how people did not request or receive them, but those complaints have decreased drastically. They also looked into providers who billed for an unusually high volume of tests. They took immediate action in the last quarter to hold all payments for COVID-19 OTC tests on June 22, 2023. They also implemented about 150 provider payment suspensions while they investigated.
The next quarterly National Stakeholder Call with CMS Administrators will be held virtually in January 2024 (no date has officially been announced). These meetings are open to the public and only require participants to register for the event beforehand. CMS National Stakeholder Calls provide an opportunity for CMS to share information related to policies or initiatives with the stakeholder community at large. National Stakeholder calls are intended for all stakeholders who interact with CMS programs, policies, or initiatives or work with providers, beneficiaries, or consumers who rely on CMS services. To learn more about CMS initiatives and updates, select ‘Centers for Medicare and Medicaid Services” under ‘Topics’ on CHS’ Trends in Transformation blog.