CMS Roundup (Aug. 25, 2023)


The Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.

CMS Releases Tools for Partners to Use to Reach Children and Families on Medicaid Renewals  — Including Strategies for Keeping Them Covered

August 11: CMS is leading a call to action to every federal and state agency that works with children and families to get the word out about Medicaid renewals and help people maintain health coverage. The all-hands-on-deck effort by the Department of Health and Human Services (HHS) shares resources and information that external partners (health plans, health care providers, advocates, employers, as well as civil rights, faith-based, health industry, and other community organizations) can use to help spread the word and help keep kids covered as states return to regular Medicaid renewals.

CMS Approves Vermont Postpartum Medicaid State Plan Amendment Coverage Extension

August 11: CMS marked another important maternal health milestone by approving a postpartum coverage extension for Vermont. This approval, made possible by the American Rescue Plan, marks 36 states, the District of Columbia, and the U.S. Virgin Islands that have extended postpartum Medicaid coverage to a full year. Postpartum coverage extensions form one of the cornerstones of CMS’ Maternity Care Action Plan  part of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis.

CMS Releases Early 2023 Snapshot Report and Full Year 2022 Effectuated Enrollment Data for Affordable Care Act Marketplaces, Showing Increases in Health Insurance Coverage, Premium Assistance, and Cost Sharing Reductions

August 11: CMS released the Early 2023 Snapshot Report and Full Year 2022 Effectuated Enrollment and Financial Assistance Data for the individual market federal and state-based Marketplaces. Effectuated enrollment reflects the total number of people who selected a plan and who also paid their premium, if applicable. Key findings from this report show 15.7 million effectuated enrollees for February 2023, which is a 13% increase from 13.8 million consumers who had effectuated coverage in February 2022. The increased coverage over this period reflects continued impacts of the advance payments of the premium tax credit (APTC) expansion provided by the American Rescue Plan (ARP) and the Inflation Reduction Act (IRA). In February 2023, 14.3 million Marketplace enrollees, or 91% of total Marketplace enrollees, received APTC, a 15% increase from the 12.5 million enrollees who received APTC in February 2022. Additionally, cost-sharing reduction (CSR) assistance enrollment increased by 11% from 6.8 million consumers in February 2022 to 7.6 million consumers in February 2023. Both APTCs and CSR assistance support the growth of effectuated enrollment by helping to make health insurance coverage affordable for millions of Americans.

CMS Releases Request for Applications for the Making Care Primary Model

August 14: CMS released the Request for Applications for the Making Care Primary (MCP) Model,  which is a new voluntary primary care model that will be tested in eight states: Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington. Launching July 1, 2024, the MCP model’s goals are to improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients’ health needs as well as their health-related social needs, such as housing and nutrition. The Request for Applications (RFA) details model eligibility, payment, care delivery, quality, and other policies.

CMS Issues Bulletin Advising that Mandatory Spousal Impoverishment Provisions for Home- and Community-Based Services (HCBS) in Medicaid are Extended through September 2027

August 15: CMS released an informational bulletin notifying states that mandatory financial eligibility rules (spousal impoverishment provisions) for  married applicants and beneficiaries eligible for home- and community-based services (HCBS) in Medicaid are extended to September 30, 2027, consistent with the Consolidated Appropriations Act, 2023. Under the Medicaid spousal impoverishment provisions, a certain amount of the couple’s combined resources is protected for the spouse living in the community. The extension helps married individuals seek coverage of certain long-term services and supports they need to stay healthy.

CMS Approves New Jersey’s Application of its State Innovation Waiver for an Additional Five Years — Lowering Individual Market Premiums and Resulting in More Consumers Being Covered 

August 15: HHS and the U.S. Department of the Treasury approved New Jersey’s State Innovation waiver extension, known as the Health Insurance Premium Security Plan, for an additional five years from Plan Years (PY) 2024 through 2028. The Departments have determined that New Jersey’s Section 1332 waiver extension plan meets the requirements outlined in Section 1332(b)(1) of the ACA. Actuarial analysis performed on behalf of New Jersey projected that in PY 2024, with the extension of the enhanced Premium Tax Credit (PTC) from the Inflation Reduction Act of 2022, statewide premiums will be on average 15.8% lower for individual health insurance coverage compared to the without-waiver baseline.  

CMS Highlights Hospice Program Integrity Actions and Strategies to Combat Fraudulent Billing

August 22: CMS published a blog summarizing the actions that CMS is taking related to fraudulent activity by some hospice care providers. CMS revisited and revitalized our hospice program integrity strategy, focusing on identifying bad actors and addressing fraudulent activity to minimize impacts to beneficiaries in the Medicare program. For example, as of mid-August, CMS has made unannounced site visits to over 7,000 hospices, as part of our nationwide project to visit every Medicare-enrolled hospice, to make sure that each hospice is operational at the address listed on the enrollment form. If a hospice was not operational at the address listed on their Medicare enrollment form, CMS exercised or will exercise its authority to either deactivate or revoke the hospice’s Medicare billing privileges. As of mid-August, nearly 400 hospices are being considered for potential administrative action. Our goal is to protect patients and their families from engaging with fraudulent actors. Please read the blog for additional strategies CMS is implementing to combat hospice billing fraud.

Other Recent Releases:

August 21: CMS Issues Draft Guidance on New Program to Allow People with Medicare to Pay Out-of-Pocket Prescription Drug Costs in Monthly Payments

August 24: CMS Releases PY 2022 Medicare Shared Savings Program Financial and Quality  Performance Results — Accountable Care Organizations (ACOs) Saved Medicare Money While Continuing to Deliver High-Quality Care

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