The countywide jobless rate in August, based on preliminary EDD estimates, was 6.2%, compared to 6% in July.

According to data, the August rate was more than a half-percentage point above the year-ago level, when countywide unemployment stood at 5.5%.

Mecca had the highest unemployment rate countywide in July at 14.7%, followed by Coachella at 14.2%, Cherry Valley at 11%, Rancho Mirage at 8.7% and Indio at 8.6%.

The combined unemployment rate for Riverside and San Bernardino counties — the Inland Empire — in August was 6%, up from 5.9% in July, the EDD said.

Bi-county data indicated payrolls shrank by the widest margin in the agricultural sector, which shed a total 2,500 positions. The construction, financial services, hospitality, information technology and manufacturing sectors recorded aggregate losses totaling 2,300.

Miscellaneous unclassified industries additionally shed about 700 jobs, according to figures.

In the plus column, across the IE, the health services, professional business services, public and transportation sectors increased payrolls by an estimated 10,000 positions.

Only the mining sector was unchanged in August.

The statewide non-seasonally adjusted unemployment rate last month was 5.9%.

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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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The Centers for Medicare & Medicaid Services (CMS) today approved proposals from California and Kentucky for community-based mobile crisis intervention teams to provide Medicaid crisis services. This marks six states that have expanded access to community-based mental health and substance use crisis care through President Biden’s American Rescue Plan. California and Kentucky will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year.

“Everyone should have access to behavioral health support where they are, when they need it – especially those who are in crisis,” said Health & Human Services Secretary Xavier Becerra. “This decision ensures that Californians and Kentuckians will have access to mobile crisis and other community-based supports. These resources will help to improve and save lives.”

“California and Kentucky recognize the vital importance of breaking down barriers to meet people in crisis with the care they need,” said CMS Administrator Chiquita Brooks-LaSure. “With these approvals, California and Kentucky join a growing number of states in helping connect people to qualified health professionals as the first point of care during a crisis. This ensures people can get the care they need when and where they need it.”

The Biden-Harris Administration has made addressing the nation’s mental health crisis a top priority, and this new option gives states an opportunity to support community-based mobile crisis intervention teams to provide services for individuals with Medicaid. Mobile crisis intervention teams aim to provide rapid response, individual assessment, and crisis de-escalation by trained behavioral health professionals and paraprofessionals. The multidisciplinary team provides screening and assessment; stabilization and de-escalation; and coordination with and referrals to health, social, and other services, as needed. This helps states better integrate behavioral health services into their Medicaid programs – a cornerstone of the sustainable, public health-focused support networks our communities need.

Providing fast, appropriate care to someone in crisis may reduce the need for costly inpatient services, and this new option will help California and Kentucky expand access to behavioral health professionals as the initial contact for someone in crisis. California’s and Kentucky’s state plan amendments add mobile crisis response crisis planning; facilitation of a warm handoff; referrals to ongoing supports; and follow up check-ins for individuals experiencing a mental health or substance use disorder crisis. Kentucky is also adding other services to the crisis continuum, including stabilization services beyond those provided by mobile crisis teams, which are delivered in the community following a crisis event.

Additionally, to help further address behavioral health needs, this month Health & Human Services and its 988 Lifeline partners announced the addition of Spanish text and chat services. Specialized services for LGBTQI+ youth and young adults were also added earlier this month, following a successful pilot test earlier this year. The 988 Lifeline is part of the Biden-Harris Administration’s comprehensive strategy to address the nation’s mental health crisis, and to-date, the Administration has invested nearly $1 billion into this life-saving initiative. This investment is driving an increase in calls, texts, and chats, with nearly 5 million contacts answered in the past year – and helped millions of people in crisis.

Today’s announcement is the latest in Health & Human Services’ ongoing efforts to support President Biden’s whole-of-government strategy to transform mental health services for all Americans – a key part of the President’s Unity Agenda. For more information on California’s and Kentucky’s approval, visit Medicaid.gov.

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“The Biden-Harris Administration is committed to expanding access to vital prevention and treatment services,” said HHS Secretary Xavier Becerra.  “Providing whole person support and services through Medicare will improve health and wellbeing for millions of Americans and even save lives.” 

“Access to services promoting behavioral health, wellness, and whole-person care is key to helping people achieve the best health possible,” said CMS Administrator Chiquita Brooks-LaSure. “The Physician Fee Schedule final rule ensures that the people we serve will experience coordinated care and that they have access to prevention and treatment services for substance use, mental health services, crisis intervention, and pain care.”

“Together, we are building a stronger Medicare program,” said Deputy Administrator and Director for the Center for Medicare, Dr. Meena Seshamani. “No matter who you are, or what diagnoses you have, these changes will help ensure that Medicare treats the whole person— caring for physical health, behavioral health, and social needs that are integral to health— and ensuring access to the high-quality care all people deserve.”

Coverage for Behavioral Health Services and Opioid Use Disorder Treatment

In line with the 2022 CMS Behavioral Health Strategy, CMS is strengthening access to vital behavioral health services. CMS is making it easier for Medicare beneficiaries to get behavioral health services, by allowing behavioral health clinicians like licensed professional counselors and marriage and family therapists to offer services under general (rather than direct) supervision of the Medicare practitioner. Medicare will pay Opioid Treatment Programs that use telecommunications with patients to initiate treatment with buprenorphine. CMS is also clarifying that Opioid Treatment Programs can bill for opioid use disorder treatment services provided through mobile units, such as vans, in accordance with Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) guidance.  These policies may increase access in rural and other underserved areas.

CMS is also finalizing policies to pay for clinical psychologists and licensed clinical social workers to furnish integrated behavioral health care as part of a primary care team. Finally, Medicare will provide a new monthly payment for comprehensive treatment and management services for patients with chronic pain. These new services offer a whole-person approach to care.

Expanding and Enhancing Accountable Care
CMS is finalizing changes to the Medicare Shared Savings Program, the nation’s largest Accountable Care Organization program, covering more than 11 million people with Medicare and including more than 500,000 health care providers. These policies represent some of the most significant reforms since the program was established in 2011, and the first Accountable Care Organizations (ACOs), which are groups of health care providers who come together to give coordinated, high-quality care to people with Medicare, began participating in 2012. Through these policies, which are central to the Medicare Value-Based Care Strategy, CMS will take important steps toward our 2030 goal of having 100% of Traditional Medicare beneficiaries in an accountable care relationship with their healthcare provider by 2030. CMS is finalizing proposals to incorporate advance shared savings payments to certain new ACOs that can be used to support their participation in the Shared Savings Program, including hiring additional staff or addressing social needs of people with Medicare. CMS is also finalizing a health equity adjustment to an ACO’s quality score, revising the benchmarking methodology, and allowing longer periods of time for ACOs to become accustomed to accountable care before being liable for downside risk, all of which are expected to increase participation in rural and underserved areas.

Reducing Barriers and Expanding Coverage for Colon Cancer Screening

Colon and rectal cancers continue to be a leading cause of death in the United States with even higher new cases and death rates for Black Americans, American Indians, and Alaska Natives. Medicare will now reduce the minimum age for colorectal cancer screening from 50 to 45 years, in alignment with recently revised policy recommendations by the U.S. Preventive Services Task Force. Additionally, Medicare will now cover as a preventive service a follow-on screening colonoscopy after a non-invasive stool-based test returns a positive result, which means that beneficiaries will not have out-of-pocket costs for both tests.

Finalizing Payment for Dental Services that are Integral to Covered Medical Services

CMS is codifying current policies in which Medicare Parts A and B pay for dental services when that service is integral to treating a beneficiary’s medical condition. Medicare will also pay for dental examinations and treatments in more circumstances, such as to eliminate infection preceding an organ transplant and certain cardiac procedures beginning in CY 2023 and prior to treatment for head and neck cancers beginning in CY 2024. Finally, CMS is establishing an annual process to review public input on other circumstances when payment for dental services may be allowed.

Payment Rates for CY 2023

The CY 2023 PFS conversion factor is $33.06, a decrease of $1.55 to the CY 2022 PFS conversion factor of $34.61. This conversion factor reflects the statutorily required update of 0% for CY 2023, expiration of the temporary 3% supplemental increase in PFS payments for CY 2022 provided by the Protecting Medicare and American Farmers From Sequester Cuts Act, and the statutorily required budget neutrality adjustment to account for changes in payment rates.

For a fact sheet on the CY 2023 Physician Fee Schedule Final Rule, please visit: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule

For a fact sheet on final changes to the CY 2023 Quality Payment Program, please visit: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/2136/2023%20Quality%20Payment%20Program%20Final%20Rule%20Resources.zip

For a fact sheet on final changes to the Medicare Shared Savings Program, please visit: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule-medicare-shared-savings-program

For a CMS blog on behavioral health polices, please visit: https://www.cms.gov/blog/strengthening-behavioral-health-care-people-medicare-0?check_logged_in=1

To view the CY 2023 Physician Fee Schedule and Quality Payment Program final rule, please visit: https://www.federalregister.gov/public-inspection/2022-23873/medicare-and-medicaid-programs-cy-2023-payment-policies-under-the-physician-fee-schedule-and-other

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