CMS Roundup (Oct. 20, 2023)

Date:

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

CMS Approves Mobile Crisis Intervention Services for People with Medicaid in the States of Washington and Montana

CMS recently approved mobile crisis state plan amendments (SPAs) for both Washington and Montana. Authorized under President Biden’s American Rescue Plan (ARP), mobile crisis intervention services provide rapid, critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option will help states integrate these services into their Medicaid programs, a critical component in establishing a sustainable, public health-focused support network. The Washington SPA was approved October 10, and the Montana SPA was approved October 17.

CMS Releases Second Evaluation Report for the Medicare Advantage Value-Based Insurance Design (VBID) Model, Phase II

October 10: CMS released an evaluation report for implementation years 2020-2022 of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model. The model tested various changes put in place to improve the delivery and quality of care for Medicare Advantage enrollees, including how to reach more effectively those with low socioeconomic status. Two key findings are that model participation is growing, including for the hospice benefit, and that interventions like supplemental benefits and Part D cost-sharing reductions are increasingly focused on addressing the needs of those with low socioeconomic status. The model is part of CMS efforts to address patients’ health-related social needs, increase prescription drug affordability, and advance health equity.

CMS Publishes Update on the Executive Order to Lower Prescription Drug Costs

October 11: CMS published a blog highlighting the first anniversary of the Executive Order on Lowering Prescription Drug Costs for Americans. The blog provides a progress report on the three models being developed to improve prescription drug affordability and access for Medicare and Medicaid beneficiaries: the Medicare $2 Drug List Model, the Cell and Gene Therapy Access Model, and the Accelerating Clinical Evidence Model. Addressing drug affordability and accessibility for Americans remains a top priority for CMS and the Biden-Harris Administration.

CMS Releases Information on Three National Coverage Determinations:

CMS continues its commitment, through national coverage determinations (NCDs), to ensure that people with Medicare have access to emerging treatments and technologies that will improve health outcomes.

October 10: CMS announced that the final NCD on Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus (HIV) Infection would not be posted by the expected date of October 10. CMS received comments on the proposed NCD that expressed concern over the potentially complex transition of coverage of these preventive drugs from Part D to Part B.  CMS will work with Part D plans and pharmacies to facilitate an orderly transition as we work towards finalizing the NCD. A final NCD will be forthcoming. Information on the proposed NCD is found here.

October 11:  CMS issued a final NCD for Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting. This NCD resulted from a request from the Multispecialty Carotid Alliance (MSCA) for a reconsideration of a former NCD. The procedure restores blood flow when arteries are clogged due to peripheral artery disease. In the final NCD, CMS expanded coverage of PTA of the carotid artery with stenting for a broader population and allowed Medicare Administrative Contractors (MACs) to make reasonable and necessary determinations for any other beneficiary seeking coverage.  

October 13: CMS announced a final decision to remove the NCD for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease, permitting Medicare coverage determinations to be made by the MACs. Removing the NCD also removes the current limitation of one PET beta-amyloid scan per lifetime from the coverage requirements.

CMS Releases Tools and Resources  as Annual Medicare Open Enrollment Period Begins

October 15: The annual Medicare Open Enrollment period began October 15, 2023, and ends December 7, 2023, with coverage changes taking effect January 1, 2024. During this time, people with Medicare can compare coverage options, like Traditional Medicare and Medicare Advantage, choose health and drug plans for 2024, and learn about extra help available to those with limited income and resources to pay for Medicare drug coverage. Tools and resources are available at Medicare.gov.

CMS Approves Montana’s Expansion of Postpartum Coverage for a Full Year to People with Medicaid

October 16: CMS approved a state plan amendment for Montana to extend postpartum coverage for a full year for individuals enrolled in Medicaid. The opportunity to extend postpartum coverage was made possible under the American Rescue Plan and made permanent in the Consolidated Appropriations Act, 2023. Montana’s approval marks 38 states, D.C., and the U.S. Virgin Islands that have extended postpartum Medicaid coverage for an entire year. This approval supports the CMS Maternity Care Action Plan and Biden-Harris Maternal Health Blueprint.    

CMS Releases Million Hearts Cardiovascular Disease Risk Reduction Model Final Evaluation

October 17: CMS released the final evaluation report of the Million Hearts Cardiovascular Disease Risk Reduction Model. The report describes the model’s implementation and includes estimates of the model’s impact on heart attacks, strokes, survival, and spending. Over five years, the model reduced the incidence of first-time heart attacks and strokes by 3 to 4 percent in all-cause mortality among high- and medium-risk beneficiaries but did not measurably impact Medicare fee-for-service spending.

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