PALM DESERT, CA — The U.S. News & World Report’s annual rating of senior care facilities showed five Inland Empire properties ranked in the top 25 in the state of California, according to the study.

This is the third year that U.S. News has compiled a comprehensive guide to identify top-rated senior living communities, including the best independent living, memory care, assisted living, and continuing care retirement communities. What makes an Independent Senior Living Community the best?

Communities identified as “the best” in the state, we narrowed the list to look at ranked Independent Senior Living Communities. These are places for 55 and up residents with no distinct special needs. They can include local transportation, yard work, social activities, group meals, and more. According to the study, these are typically not covered by Medicare.

The top 5 Independent Senior Living Communities in the Inland Empire 2024 were:

1. Plymouth Village – 900 Salem Drive, Redlands: Managed by HumanGood
2. Bella Villagio – 40-235 Portola Avenue, Palm Desert: Managed by Leisure Care, LLC
3. Menifee Lakes– 29914 Antelope Road, Menifee
4. Solstice Senior Living at Apple Valley – 20594 Bear Valley Road, Apple Valley: Managed by Solstice Senior Living
5. Holiday Golden Oaks– 33398 Oak Glen Road, Yucaipa: Managed by Holiday by Atria.
   
   Many of the above communities are considered “Continuing Care Retirement Communities,” or facilities that provide multiple levels of care in one location, allowing residents to stay in the same place as their needs change over time. Several are part of a larger network of management companies.

Many of the top 5 Inland Empire Independent Senior Living Communities also have high-end hospitality and concierge-level personalization and dining experiences, as in the case of Bella Villagio in Palm Desert. Residents of the Leisure Care, LLC property can enjoy amenities from laundry service to transportation. Making life easier for 55 and up, there are pools to an on-property theater, a hair salon, a bistro, a library, and complimentary Wi-Fi. Residents can also travel with Leisure Care, and take part in daily activities and wellness programs. Commenters say the space is “beautiful, clean and comfortable” and that they the social aspects of “dining, exercise and fun activities.”

Sumita Singh, general manager of Health at U.S. News, spoke about the project and what made it different for 2024.

“Best Senior Living reflects U.S. News’ commitment to helping families navigate the important and complex decision of researching and choosing a senior living community through trusted, data-backed community ratings,” Singh said. They recognize “stand out communities as “Best” when they provide exceptional care and satisfaction.

To receive a “Best” rating, individual locations had to earn a specific final weighted score tabulated in the independent methodology developed by the U.S. News health data analytics team.

In California, among the top 380 communities identified in the 2024 ratings, the following management companies managed several of the Golden State’s Best Independent Senior Living Communities:

• HumanGood
• Kisco Senior Living
• Leisure Care, LLC
• Vi Living
• Atria Senior Living / Holiday by Atria
• Solstice Senior Living
• Revel Communities

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During his visit to the Inland Empire as part of his “National Latino Health Tour,” Secretary Becerra emphasized the positive impact of the Biden Administration’s Inflation Reduction Act.

“We have to remember that there were days before the Inflation Reduction Act became law and lowered the price of insulin, people were having to ration their insulin and make decisions about what to do in their daily lives if they wanted to afford it,” said Becerra. “Today, people paying no more than $35 for insulin when on Medicare is a big deal, and the fact that we now have the ability to negotiate the prices on medicine is huge.”

The $35 insulin cost cap is set to benefit 108,164 Californians on Medicare who use insulin, addressing a critical need in a state where one 10-milliliter vial of insulin can cost up to $400; a person usually needs two to three vials a month. “This is the right thing to do for our patient care. We are going to continue lowering the cost of healthcare here in the Inland Empire because it matters to people,” said Rep. Aguilar.

Further emphasizing the Act’s impact, Rep. Aguilar highlighted that drug negotiations will benefit more than 830,000 California Medicare enrollees, saving them between $64 and $4,297 in out-of-pocket costs for the first ten drugs subject to price negotiations.

Additionally, the Act ensures that recommended vaccines are now free for the more than 1.2 million Latinos in California enrolled in Medicare, and introduces a $2,000 annual out-of-pocket cost cap, effective in 2025, which will save 203,210 Californians an average of $341.84.

Secretary Becerra also noted the historic increase in Latino enrollment in health coverage through the Affordable Care Act, which jumped by 53% from 2020 to 2022, helping more than 900,000 Latinos nationwide gain health insurance than ever before.

The press event also featured a fireside chat between Congressman Pete Aguilar and Secretary Becerra, where they discussed important issues like the Affordable Care Act, health insurance, medication prices, and mental health. A SAC Health patient named Sheila provided a poignant testimony on the importance of insulin and the recent struggles faced in terms of cost and accessibility, underscoring the significance of the measures announced.

As the Inland Empire and the broader Californian community look forward to these changes, the hope is that the Inflation Reduction Act will pave the way for a healthier and more affordable future for all.

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WASHINGTON (AP) — New obesity drugs are showing promising results in helping some people shed pounds but the injections will remain out of reach for millions of older Americans because Medicare is forbidden to cover such medications.

Drugmakers and a wide-ranging and growing bipartisan coalition of lawmakers are gearing up to push for that to change next year.

As obesity rates rise among older adults, some lawmakers say the United States cannot afford to keep a decades-old law that prohibits Medicare from paying for new weight loss drugs, including Wegovy and Zepbound. But research shows the initial price tag of covering those drugs is so steep it could drain Medicare’s already shaky bank account.

A look at the debate around if — and how — Medicare should cover obesity drugs:

WHAT OBESITY DRUGS ARE ON THE MARKET AND HOW DO THEY WORK?

The Food and Drug Administration has in recent years approved a new class of weekly injectables, Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, to treat obesity.

People can lose as much as 15% to 25% of their body weight on the drugs, which imitate the hormones that regulate appetites by communicating fullness between the gut and brain when people eat.

The cost of the drugs, beloved by celebrities, has largely limited them to the wealthy. A monthly supply of Wegovy rings up at $1,300 and Zepbound will put you out $1,000. Shortages for the drugs have also limited the supplies. Private insurers often do not cover the medications or place strict restrictions on who can access them.

Last month, a large, international study found a 20% reduced risk of serious heart problems such as heart attacks in patients who took Wegovy.

WHY DOESN’T MEDICARE COVER THE DRUGS?

Long before Oprah Winfrey and TikTok influencers alike gushed about the benefits of these weight loss drugs, Congress made a rule: Medicare Part D, the health insurance plan for older Americans to get prescriptions, could not cover medications used to help gain or lose weight. Medicare will cover obesity screening and behavioral treatment if a person has a body mass index over 30. People with BMIs over 30 are considered obese.

The rule was tacked onto legislation passed by Congress in 2003 that overhauled Medicare’s prescription drug benefits.

Lawmakers balked at paying high costs for drugs to treat a condition that was historically regarded as cosmetic. Safety problems in the 1990s with the anti-obesity treatment known as fen-phen, which had to be withdrawn from the market, were also fresh in their minds.

Medicaid, the state and federal partnership program for low-income people, does cover the drugs in some areas, but access is fragmented.

THE CONVERSATION IS SHIFTING

New studies are showing the drugs do more than help patients slim down.

Rep. Brad Wenstrup, R-Ohio, introduced legislation with Rep. Raul Ruiz, D-Calif., this year that would allow Medicare to cover the now-forbidden anti-obesity drugs, therapy, nutritionists and dietitians.

“For years there was a stigma against these people, then there was a stigma about talking about obesity,” Wenstrup said in an interview with The Associated Press. “Now we’re in a place where we’re saying this is a health problem we need to deal with this.”

He believes the intervention could alleviate all sorts of ailments associated with obesity that cost the system money.

“The problem is so prevalent,” Wenstrup said. “People are starting to realize you have to take into consideration the savings that comes with better health.”

Last year, about 40% of the nearly 66 million people enrolled in Medicare had obesity. That roughly mirrors the larger U.S. population, where 42% of adults struggle with obesity, according to the Centers for Disease Control and Prevention.

Notably, Medicare does cover certain surgical procedures to treat medical complications of obesity in people with a BMI of 35 and at least one related condition. Congress approved the exception in 2006, noted Mark McClellan, a former head of the Centers for Medicare and Medicaid Services and the FDA.

The 17-year-old law may provide a blueprint for expanding coverage of the new drugs, which mirror the results of bariatric surgery in some cases, McClellan said. Evidence showed that the surgery reduced the risks of death and serious illness from conditions related to obesity.

“And that’s been the basis for coverage all this time,” McClellan said.

COST IS NOW THE ISSUE

Still, the upfront price tag for lifting the rule remains a challenge.

Some research shows offering weight loss drugs would assure Medicare’s impending bankruptcy. A Vanderbilt University analysis this year put an annual price of about $26 billion on anti-obesity drugs for Medicare if just 10% of the system’s enrollees were prescribed the medication.

Other research, however, shows it could also save the government billions, even trillions over many years, because it would reduce some of the chronic conditions and problems that stem from obesity.

An analysis this year from the University of Southern California’s Schaeffer Center estimated the government could save as much as $245 billion in a decade, with the majority of savings coming from reducing hospitalizations and other care.

“What we did is we looked at the long-term health consequences of treating obesity in the Medicare population,” said the study’s co-author, Darius Lakdawalla, the director of research at the center. The Schaeffer Center receives funding from pharmaceutical companies, including Eli Lilly.

Lakdawalla said it’s nearly impossible to put a cost on covering the drugs because no one knows how many people will end up taking them or what the drugs will be priced at.

The Congressional Budget Office, which is tasked with pricing out legislative proposals, acknowledged this difficulty in an October blog post, with the director calling for more research on the topic.

Overall, the agency “expects that the drug’s net cost to the Medicare program would be significant over the next 10 years.”

The cost of the legislation is the biggest hang up in getting support, Ruiz said.

“When we talk about the initial cost, I often have to educate the members that the CBO does not take into account cost savings in their cost benefit analysis,” Ruiz told the AP. “Taking that number in isolation, one does not get the full picture of the full economies of reducing obesity and all of its comorbidities in our patients.”

WHO WANTS MEDICARE TO COVER THE DRUGS?

Doctors say weight loss drugs are only a part of the most effective strategies to treat a patient with obesity.

When Dr. Andrew Kraftson develops a plan with his patients at the University of Michigan’s Weight Navigator program, it involves a “perfect marriage” of behavioral intervention, health and diet education, and possibly anti-obesity medication.

But with Medicare patients, he is limited in what he can prescribe.

“A blanket prohibition for use of anti-obesity medication is an antiquated way of thinking and does not recognize obesity as a disease and is perpetuating health disparities,” Kraftson said. “I’m not so ignorant to think that Medicare should just start covering expensive treatments for everyone. But there is something between all or nothing.”

Lawmakers have introduced some variation of legislation that would permit Medicare coverage of weight loss drugs over the last decade. But this year’s bill has garnered interest from more than 60 lawmakers, from self-proclaimed budget hawk Rep. David Schweikert, R-Ariz., to progressive Rep. Judy Chu, D-Calif.

Passage is a top priority for two lawmakers, Wenstrup and Sen. Tom Carper, D-Del., before they retire next year.

Pharmaceutical companies also are readying for a lobbying blitz next year with the drugs getting the OK from the FDA to be used for weight loss.

“Americans should have access to the medicines that their doctors believe they should have,” Stephen Ubl, the president of the lobbying group, Pharmaceutical Research and Manufacturers of America, said on a call with reporters last week. “We would call on Medicare to cover these medicines.”

Already, Novo Nordisk has employed eight separate firms and spent nearly $20 million on lobbying the federal government on issues, including the Treat & Reduce Obesity Act, since 2020, disclosures show. Eli Lilly has spent roughly $2.4 million lobbying since 2021.

Advocates for groups such as the Obesity Society have been pushing for Medicare coverage of the medications for years. But the momentum may be shifting, thanks to the growing evidence that the obesity drugs can prevent strokes, heart attacks, even death, said Ted Kyle, a policy advisor.

“The conversation has shifted from debating whether obesity treatment is worthwhile to figuring out how to make the economics work,” he said. “This is why I now believe the change is inevitable.”

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The Centers for Medicare & Medicaid Services’ (CMS’) proposed rule will help people with Medicare select and enroll in coverage options that best meet their health care needs by preventing plans from engaging in anti-competitive steering of prospective enrollees based on excessive compensation to agents and brokers, rather than the enrollee’s best interests. The proposed guardrails protect people with Medicare and promote a competitive marketplace in Medicare Advantage, consistent with the goals of President Biden’s historic Executive Order on Promoting Competition in the American Economy. 

The proposed rule will also improve access to behavioral health care by adding a new facility type that includes several behavioral health provider types to Medicare Advantage network adequacy requirements. CMS is also proposing policies to increase the utilization and appropriateness of supplemental benefits to ensure taxpayer dollars actually provide meaningful benefits to enrollees. Additionally, the proposed rule would improve transparency on the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly substitute lower cost biosimilar biological products for their reference products.

“The Biden-Harris Administration remains committed to making health care more affordable and accessible for all Americans. By ensuring Medicare recipients have the information they need to make critical decisions about their health care coverage, we are doing just that,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “Promoting competition in the marketplace helps to lower costs and protect access to care while making the whole process more transparent and accountable.”

“CMS continues to improve the Medicare Advantage and Part D prescription drug programs and maintain high-quality health care coverage choices for all Medicare enrollees,” said CMS Administrator Chiquita Brooks-LaSure. “People with Medicare deserve to have accurate and unbiased information when they make important decisions about their health coverage. Today’s proposals further our efforts to curb predatory marketing and inappropriate steering that distorts healthy competition among plans.” 

CMS has previously taken unprecedented steps to address predatory marketing of Medicare Advantage plans, such as banning misleading TV ads. Many people on Medicare rely on agents and brokers to help navigate Medicare choices. CMS is concerned that some Medicare Advantage plans are compensating agents and brokers in a way that may circumvent existing payment rules, inappropriately steer individuals to enroll in plans that do not best meet their health care needs, and lead to further consolidation in the Medicare Advantage market. To further protect people with Medicare through stronger marketing policies and to promote a competitive marketplace in Medicare Advantage, CMS is proposing added guardrails to plan compensation for agents and brokers, including standardization. These proposals are consistent with the statutory requirement that CMS develop guidelines to ensure that the use of compensation creates incentives for agents and brokers to enroll individuals in the Medicare Advantage plan that is intended to best meet their health care needs. 

CMS also proposes to strengthen and improve access to behavioral health care by adding a new facility type, which includes marriage and family therapists, mental health counselors, addiction medicine clinicians, opioid treatment providers, and others, to CMS’ Medicare Advantage network adequacy requirements. This proposed addition builds on changes finalized last year to strengthen these requirements and would ensure people with Medicare Advantage can access vital mental health and substance use disorder treatment.

“The people we serve are at the center of the Medicare program, and we work each day to make sure the program works for them. Agents and brokers play an important role in guiding people with Medicare to the option that is tuned in to their medical needs. Our proposals on how plans compensate agents and brokers seek to support a competitive marketplace that best serves people with Medicare,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare.

Currently, 99% of Medicare Advantage plans offer at least one supplemental benefit. Over time, the benefits offered have become broader in scope and variety, with more rebate dollars directed toward these benefits. CMS is committed to ensuring these offerings are effectively reaching enrollees and actually meeting their needs, and not just used for attracting enrollees. In today’s rule, CMS proposes requiring Medicare Advantage plans to send a personalized notification to their enrollees mid-year of the unused supplemental benefits available to them to encourage higher utilization. Furthermore, CMS is proposing additional requirements designed to help ensure that benefits offered as special supplemental benefits for the chronically ill (SSBCI) are backed by evidence. CMS is also proposing new marketing and transparency guardrails around these benefits. These proposals will help ensure a robust and competitive Medicare Advantage marketplace made up of plan options with meaningful benefits.

Additionally, CMS is concerned that certain prior authorization policies may disproportionately inhibit access to needed care for underserved enrollees. To provide additional safeguards, CMS is proposing to require that Medicare Advantage plans include an expert in health equity on their utilization management committees and that the committees conduct an annual health equity analysis of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors—eligibility for Part D low-income subsidies, dual eligibility for Medicare and Medicaid, or having a disability—compared to enrollees without these risk factors. These analyses would have to be posted publicly to improve transparency into the effects of prior authorization on underserved populations. To further promote health equity, CMS is also proposing to streamline enrollment options for individuals with both Medicare and Medicaid, providing more opportunities for integrated care. 

To support competition in the prescription drug marketplace, CMS is also proposing to provide more flexibility to substitute biosimilar biological products other than interchangeable biological products for their reference products to give people with Medicare more timely access to lower-cost biosimilar drugs. This proposal would permit Part D plans to treat such substitutions as maintenance changes so that the substitutions apply to all enrollees, not only those who begin the therapy after the effective date of the change, following a 30-day notice.

There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted at one of the addresses provided in the Federal Register no later than January 5, 2024. The proposed rule can be accessed at the Federal Register at https://www.federalregister.gov/public-inspection/2023-24118/medicare-program-contract-year-2025-policy-and-technical-changes-to-the-medicare-advantage-program

View a fact sheet on the proposed rule at cms.gov/newsroom.

View the CMS Blog Important New Changes to Improve Access to Behavioral Health in Medicare at https://www.cms.gov/blog.

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The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Shared Savings Program saved money for Medicare while continuing to support high-quality care. Specifically, the program saved Medicare $1.8 billion in 2022 compared to spending targets for the year. This marks the sixth consecutive year the program has generated overall savings and high-quality performance results. This represents the second-highest annual savings accrued for Medicare since the program’s inception more than ten years ago. 

“This program has delivered more than $1.8 billion in savings and delivered high-quality health care to millions of people,” said HHS Secretary Xavier Becerra. “Just last month, we proposed ways to further grow and expand this successful program, especially in rural and other underserved communities. The Biden-Harris Administration will continue to do everything we can to strengthen Medicare and ensure everyone can access high-quality, affordable health care.” 

“The Medicare Shared Savings Program helps millions of people with Medicare experience coordinated health care while also reducing costs for the Medicare program,” said CMS Administrator Chiquita Brooks-LaSure. “CMS will continue to improve the program, and it is exciting to see that Accountable Care Organizations are continuing to be successful in delivering coordinated, high-quality, affordable, equitable, person-centered care.” 

Shared Savings Program Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who collaborate and provide coordinated, high-quality care to people with Medicare, focusing on delivering the right care at the right time while avoiding unnecessary services and medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program (also known as performance payments). This also drives lower health care costs for people with Medicare, who see lower out-of-pocket spending on avoidable health care utilization like emergency department visits because the ACO has better coordinated their care.

Over the past decade, the Shared Savings Program has grown into one of the largest value-based purchasing programs in the country. Value-based purchasing programs link provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide, and it attempts to reduce inappropriate care and to identify and reward the best-performing health care providers. As of January 2023, Shared Savings Program ACOs include over 573,000 participating clinicians who provide care to almost 11 million people with Medicare. Based on the program’s success and opportunities to continually improve value for people with Medicare and the health care system, CMS has set a goal that 100 percent of people with Traditional Medicare will be part of an accountable care relationship by 2030.

“We are encouraged and inspired by six consecutive years of savings and high-quality care, with 2022 being one of the strongest years of performance to date,” said Meena Seshamani, MD, PhD, CMS Deputy Administrator and Director of the Center for Medicare. “The Shared Savings Program is Medicare’s permanent, flagship Accountable Care Program, and we look forward to continually improving and growing the program, expanding the reach of participating ACOs, and addressing critical health disparities across the country.”

ACOs had a higher average performance on quality measures they are required to report in order to share in savings compared to other similarly sized clinician groups not in the program. This includes statistically significant higher performance for quality measures related to diabetes and blood pressure control; breast cancer and colorectal cancer screening; tobacco screening and smoking cessation; and depression screening and follow-up. The higher quality performance by ACOs underscores how this type of coordinated, whole-person care can improve treatment of behavioral health conditions, helping to achieve the goals of the CMS’ Behavioral Health Strategy and improve cancer screening rates and prevention in line with the goals of the Cancer Moonshot.

Approximately 63% of participating ACOs earned payments for their performance in 2022. ACOs that earned more shared savings tended to be low revenue. Low-revenue ACOs are usually ACOs that are mainly made up of physicians and may include a small hospital or serve rural areas. With $228 per capita in net savings, low-revenue ACOs led high-revenue ACOs, who had $140 per capita net savings, and low-revenue ACOs comprised of 75% primary care clinicians or more saw $294 per capita in net savings, more than twice as much. These results underscore how important primary care is to the success of the Shared Savings Program and demonstrate how the program supports primary care providers. As articulated in a recently published article, the Innovation Center continues to explore testing models and features to support Shared Savings Program ACOs in increasing investment in primary care services.

Earlier this year, in the Calendar Year (CY) 2024 Physician Fee Schedule proposed rule, CMS proposed changes to the Medicare Shared Savings Program that would promote participation among health care providers and promote equity, especially in rural and underserved areas, helping to grow this successful program and improve access to coordinated, efficient, and high-quality care provided by ACOs for more people with Medicare. In particular, CMS proposes increasing the number of people receiving high-quality, accountable care by assigning more people who receive care from nurse practitioners, physician assistants, and clinical nurse specialists to ACOs. In addition, CMS proposes changes to the benchmark methodology to encourage participation by ACOs caring for medically complex, high-cost beneficiaries to join the program.  These changes would further advance CMS’ overall value-based care strategy of growth, alignment, and equity, building on changes finalized in 2022, which included the establishment of advance investment payments for ACOs in rural and underserved communities, changes to the benchmark methodology, more time to transition to downside risk, and a health equity adjustment that rewards excellent care delivered to underserved communities.  Public comments on the CY 2024 Physician Fee Schedule proposed rule are due by September 11, 2023. 

For more information on the Medicare Shared Savings Program, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram 

For more information on the proposals for the Medicare Shared Savings Program in the CY 2024 Physician Fee Schedule proposed rule, visit https://www.federalregister.gov/documents/2023/‌‌‌08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other, or reference the Shared Savings Program Fact Sheet at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program

View the 2022 Medicare Shared Savings Program Financial and Quality performance results at https://data.cms.gov/medicare-shared-savings-program/performance-year-financial-and-quality-results/data

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WASHINGTON (AP) — U.S. officials granted full approval to a closely watched Alzheimer’s drug on Thursday, clearing the way for Medicare and other insurance plans to begin covering the treatment for people with the brain-robbing disease.

The Food and Drug Administration endorsed the IV drug, Leqembi, for patients with mild dementia and other symptoms caused by early Alzheimer’s disease. It’s the first medicine that’s been convincingly shown to modestly slow the cognitive decline caused by Alzheimer’s.

Japanese drugmaker Eisai received conditional approval from the FDA in January based on early results suggesting Leqembi worked by clearing a sticky brain plaque linked to the disease.

The FDA confirmed those results by reviewing data from a larger, 1,800-patient study in which the drug slowed memory and thinking decline by about five months in those who got the treatment, compared to those who got a dummy drug.

“This confirmatory study verified that it is a safe and effective treatment for patients with Alzheimer’s disease,” said FDA’s neurology drug director, Dr. Teresa Buracchio, in a statement.

The drug’s prescribing information will carry the most serious type of warning, indicating that Leqembi can cause brain swelling and bleeding, side effects that can be dangerous in rare cases. The label notes that those problems are seen with other plaque-targeting Alzheimer’s drugs.

The process of converting a drug to full FDA approval usually attracts little attention. But Alzheimer’s patients and advocates have been lobbying the federal government for months after Medicare officials announced last year they wouldn’t pay for routine use of drugs like Leqembi until they receive FDA’s full approval.

There were concerns that the cost of new plaque-targeting Alzheimer’s drugs could overwhelm the program’s finances, which provide care for 60 million seniors. Leqembi is priced at about $26,500 for a year’s supply of IVs every two weeks.

The vast majority of Americans with Alzheimer’s get their health coverage through Medicare. And private insurers have followed its lead by withholding coverage for Leqembi and a similar drug, Aduhelm, until they receive FDA’s full endorsement. An FDA decision on full approval for Aduhelm is still years away.

Medicare administrator, Chiquita Brooks-LaSure, said in a statement Thursday the program will begin paying for the drug now that it has full FDA approval. But the government is also setting extra requirements, including enrollment in a federal registry to track the drug’s real-world safety and effectiveness.

Medicare “will cover this medication broadly while continuing to gather data that will help us understand how the drug works,” Brooks-LaSure said.

Some Medicare patients could be responsible for paying the standard 20% of the cost of Leqembi, though the amount will vary depending on their plans and other coverage details.

Hospitals and medical clinics have cautioned that it may take time to get people started on the drug.

Doctors need to confirm that patients have the brain plaque targeted by Leqembi before prescribing it. Nurses need to be trained to administer the drug and patients must be monitored with repeated brain scans to check for swelling or bleeding. The imaging and administration services carry extra costs for hospitals beyond the drug itself.

Eisai has told investors that about 100,000 Americans could be diagnosed and eligible to receive Leqembi by 2026. The drug is co-marketed with Cambridge, Massachusetts-based Biogen.

“We want to ensure that appropriate patients only are the ones that get this product,” said Alexander Scott, a vice president with Eisai.

Eisai studied the drug in people with early or mild disease who were evaluated using a scale measuring memory, thinking and other basic skills. After 18 months, those who got Leqembi declined more slowly — a difference of less than half a point on the scale — than participants who received a dummy infusion. Some Alzheimer’s experts say that delay is likely too subtle for patients or their families to notice.

But federal health advisers said the difference could still be meaningful and recommended that FDA fully approve the drug at a public meeting in June.

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Thanks to President Biden’s new law to lower prescription drug costs, the final rule will also improve access to affordable prescription drug coverage for an estimated 300,000 low-income individuals

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is finalizing a rule to put people with Medicare first and put strong protections in place so that Medicare Advantage (MA) works for them. This final rule will strengthen Medicare Advantage and hold health insurance companies to higher standards for America’s seniors and people with disabilities by cracking down on misleading marketing schemes by Medicare Advantage plans, Part D plans and their downstream entities; removing barriers to care created by complex coverage criteria and utilization management; and expanding access to behavioral health care. The new rule will also promote health equity, and implement a key provision of the Inflation Reduction Act—President Biden’s new law to lower prescription drug costs—that will improve access to affordable prescription drug coverage for an estimated 300,000 low-income individuals.

The Biden-Harris Administration is committed to protecting and strengthening Medicare for the 65 million people with Medicare today and for future generations. In the past few months, the Department has taken a series of actions to ensure the Medicare Advantage program works for people with Medicare and that private insurance companies are held accountable for providing quality coverage and care:

• In February, CMS finalized a rule to start recovering improper payments made to Medicare Advantage plans through audits for the first time since 2007. Recovering these improper payments and returning this money to the Medicare Trust Funds will protect the fiscal sustainability of Medicare and allow the program to better serve seniors and people with disabilities, today and in the future.
• Last week, CMS finalized policies in the 2024 Medicare Advantage and Part D Rate Announcement to improve payment accuracy and ensure taxpayer dollars are appropriately safeguarded and well-spent.

“At HHS, we put seniors and people with disabilities first,” said HHS Secretary Xavier Becerra. “That is exactly what we are doing today. In our latest effort to strengthen Medicare and hold insurance companies accountable, we are putting protections in place so that Medicare Advantage works for beneficiaries and they get the quality care they deserve. We will continue our efforts to deliver on the President’s vision to strengthen this program for the millions of people with Medicare and for future generations to come.”

“The Biden-Harris Administration has made exceptionally clear that one of its top priorities is protecting and strengthening Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “With this final rule, CMS is putting in place new safeguards that make it easier for people with Medicare to access the benefits and services they are entitled to, while also strengthening the Medicare Advantage and Part D programs.”

“People with Medicare deserve to have access to accurate information when making coverage choices, and to be able to get the care they need without excessive burden or delays,” said Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare. “The commonsense policies in this rule further our goals to advance health equity, improve access to care, and drive high-quality, whole-person care.”

Cracking Down on Misleading Marketing Schemes

The final rule includes changes to protect people exploring Medicare Advantage and Part D coverage from confusing and potentially misleading marketing practices. Ads will be prohibited if they do not mention a specific plan name, or if they use the Medicare name, CMS logo, and products or information issued by the Federal Government, including the Medicare card, in a misleading way. Further, the final rule strengthens accountability for plans to monitor agent and broker activity.

Removing Barriers to Care Created by Complex Prior Authorization and Utilization Management

CMS is also providing important protections regarding utilization management policies and coverage criteria that ensure that Medicare Advantage enrollees receive the same access to medically necessary care that they would receive in Traditional Medicare. The rule streamlines prior authorization requirements and reduces disruption for enrollees by requiring that a granted prior authorization approval remains valid for as long as medically necessary to avoid disruptions in care, requiring Medicare Advantage plans to annually review utilization management policies, and requiring denials of coverage based on medical necessity be reviewed by health care professionals with relevant expertise before a denial can be issued. These policies complement proposals in CMS’ Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P).

Expanding Access to Behavioral Health Care

CMS remains committed to emphasizing the critical role that access to behavioral health plays in whole person care. In line with CMS’ Behavioral Health Strategy and the Administration’s strategy to address the national mental health crisis, CMS is strengthening behavioral health network adequacy in Medicare Advantage by adding clinical psychologists and licensed clinical social workers to the list of evaluated specialties. CMS is also finalizing wait time standards for behavioral health and primary care services and more specific notice requirements from plans to patients when these providers are dropped from their networks. In addition, CMS is requiring most types of Medicare Advantage plans to include behavioral health services in care coordination programs, ensuring that behavioral health care is a core part of person-centered care planning. 

Promoting More Equitable Care

Additionally, CMS is advancing health equity and driving quality in health coverage by establishing a health equity index in the Star Ratings program that will reward Medicare Advantage and Medicare Part D plans that provide excellent care for underserved populations. Plans will also be required to provide culturally competent care to an expanded list of populations and to improve equitable access to care for those with limited English proficiency, through newly expanded requirements for providing materials in alternate formats and languages. The final rule balances patient experience/complaints measures, access measures, and health outcomes measures in the Star Ratings program to more effectively focus both on patient-centric care and on improving clinical outcomes.

Implementing President Biden’s New Prescription Drug Law

The final rule also implements a key provision of the Inflation Reduction Act that improves access to affordable prescription drug coverage for approximately 300,000 low-income individuals. As outlined in President Biden’s new prescription drug law, CMS is expanding eligibility for the full low-income subsidy benefit (also known as “Extra Help”) to individuals with incomes up to 150% of the federal poverty level who meet eligibility criteria. Beginning January 1, 2024, this change will provide the full low-income subsidy to those who would currently qualify for the partial low-income subsidy. As a result of this change, eligible enrollees will have no deductible, no premiums (if enrolled in a “benchmark” plan), and fixed, lowered copayments for certain medications under Medicare Part D.

View a fact sheet on the final rule.

The final rule can be accessed from the Federal Register at: https://www.federalregister.gov/public-inspection/2023-07115/medicare-program-contract-year-2024-policy-and-technical-changes-to-the-medicare-advantage-program.

Medicare Advantage Value-Based Insurance Design Model Extension

Additionally, today CMS is also releasing more information about the extension of the Center for Medicare and Medicaid Innovation’s Medicare Advantage Value-Based Insurance Design (VBID) Model from 2025 through 2030. This extension will introduce changes intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness. View the fact sheet, and more information, on the model webpage.

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WASHINGTON (AP) — When President Joe Biden suggested that Republicans want to slash Medicare and Social Security, the GOP howls of protest during his State of the Union address showcased a striking apparent turnaround for the party that built a brand for years trying to do just that.

Biden is not about to let Republicans off easily and forget that history.

The record ranges from President George W. Bush’s ideas about privatizing Social Security to House Speaker Paul Ryan’s sweeping Medicare overhaul plan to current Sen. Rick Scott’s idea of allowing those and other federal programs to “sunset.”

As budget negotiations move ahead, expect the long history of GOP efforts to slash the popular entitlement programs for seniors to remain a politically powerful weapon the White House intends to wield.

“They sure didn’t like me calling them on it,” Biden said Wednesday about his address that drew heckling from Republicans the night before.

He headed to political battleground Wisconsin, home of Republican Sen. Ron Johnson, who has proposed forcing Congress to authorize spending for Social Security every year.

Speaking at a union training facility in DeForest, Biden pulled out a copy of Scott’s campaign proposals and quoted Johnson as well as Republican Sen. Mike Lee of Utah to warn that Republicans would target Social Security and Medicare.

Referring to the loud GOP objections at the State of the Union, he said, “When I called them out on it last night, it sounded like they agreed to take these cuts off the table.”

“Well, I sure hope that’s true,” he said. “I’ll believe it when I see it.”

The political shift among Republicans is happening in real time, helping set the parameters for the budget negotiations as Biden and Congress try to come up with a plan for raising the nation’s debt limit by a summer deadline.

House Speaker Kevin McCarthy has insisted that cuts to Medicare and Social Security are “off the table” — and many House and Senate Republicans vehemently agreed during Biden’s State of the Union address, some shouting “liar!” as he suggested they were proposing reductions.

But it’s unclear what Republicans will demand instead of entitlement cuts as they leverage the upcoming negotiations to extract federal spending reductions. They say they want to put the government on a path toward a balanced budget, but that’s a daunting if not impossible challenge without painful cuts elsewhere — in defense or other domestic accounts that Washington has been unable to make.

Johnson accused the president of “lying” about the senator’s approach. “I want to save these programs,” Johnson said in a statement Wednesday. “We need a process to prioritize spending and decease our deficits.”

The White House has insisted that Republicans make their budget plans public for Americans to judge for themselves. That hasn’t happened yet.

“No more saying one thing and doing another,” said White House Press Secretary Karine Jean-Pierre. “Let’s see exactly what they want to do.”

Efforts to halt the explosive growth of the federal safety net programs for older Americans have stirred and stalled for years, particularly as the nation’s population ages and more and more money is needed to shore up Medicare and Social Security.

Mandatory spending on the programs accounted for about $2.1 trillion in fiscal 2022, which ended last June 30 — a sizable chunk of the nation’s $5.8 trillion federal budget. Both funds are on track for insolvency, and the nation’s debt is climbing, already edging past the $31 trillion limit.

In 2005, then President Bush floated a proposal to partially privatize Social Security, the retirement income program mostly for seniors. Republicans in 2010 seized control of the House and elevated House Budget Chairman Ryan, the architect of a Medicare proposal to shift toward a private insurance option, to be the party’s 2012 vice presidential nominee. More recently, Scott, leader of the Senate GOP’s campaign arm, put forward his own plans for overhauling the entitlement systems for older Americans.

Biden quickly zeroed in on Scott’s proposal when the senator first introduced it more than a year ago, using it to portray Republicans as extreme. White House officials credit that with helping Democrats hold onto the Senate in last fall’s midterm elections. It’s a game-plan the president appears to be eager to deploy again as he gears up for a 2024 reelection bid.

“Politically it was genius to tag the party with this idea that this party wants to do away with Social Security,” said William Arnone, chief executive of the National Academy of Social Insurance, an advocacy organization for Social Security. “The reaction from Republicans in the room is they want nothing to do with that idea.”

Scott’s 12-point plan calls for all federal spending legislation to sunset in five years, subject to votes in Congress that could preserve programs.

“If a law is worth keeping, Congress can pass it again,” Scott’s Rescue America website states.

Scott said in a written response to the president’s State of the Union address that for Biden “to suggest that this means I want to cut Social Security or Medicare is a lie, and is a dishonest move.”

“Does he think I also intend to get rid of the U.S. Navy? Or the border patrol? Or air traffic control, maybe?” Scott asked in the statement. “This is the kind of fake, gotcha BS that people hate about Washington. I’ve never advocated cutting Social Security or Medicare and never would.”

Scott’s sunset ideas have a following among some Republicans in Congress, but at the same time the Republican Party is moving toward what appears to be a public unwillingness to touch the entitlement programs.

Senate Republican leader Mitch McConnell has distanced the party from Scott’s ideas, and the Florida Republican lost an internal party bid to oust McConnell from leadership after the 2022 midterm elections.

Sen. Mitt Romney of Utah, the party’s 2012 presidential nominee who chose Ryan as his running mate is proposing a bipartisan “Trust Act,” which would create a “Rescue Commission” for the nation’s endangered trust funds with a mandate to come up with legislation that would extend their long-term solvency.

Romney’s plan, which is gaining traction among both Republicans and Democrats, is reminiscent of the 2010 bipartisan National Commission on Fiscal Responsibility and Reform, otherwise known as the Bowles-Simpson commission. Headed by two former Democratic and Republican lawmakers. it proposed one of the most sweeping overhauls yet of the nation’s entitlement and budget programs.

Those recommendations proved politically toxic, and the Obama administration quickly distanced itself, as did many members of Congress.

During the last debt ceiling go-around, in 2011, Biden, as Obama’s vice president, helped broker deals to ease the standoff. Among the ideas? A bipartisan “Super Committee” to propose budget cuts.

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In addition to the payment updates, the Advance Notice outlines several updates and improvements made by the Inflation Reduction Act (IRA) to the Part D program that will go into effect or be in effect on January 1, 2024. These include the continuation of reduced cost-sharing for insulin and eliminated cost-sharing for recommended, preventive vaccines, as well as the elimination of cost-sharing for Part D prescription drugs in the catastrophic phase and expansion of eligibility for full cost-sharing and premium subsidies under the Low-Income Subsidy program. Through these changes to the Part D program for 2024, the new drug law provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening the Medicare program both now and in the longrun.

“Medicare Advantage and Part D prescription drug plans are essential parts of CMS’s vision that all parts of Medicare are working to provide more equitable, high quality, and person-centered care that is affordable and sustainable for the people we serve,” said CMS Administrator Chiquita Brooks-LaSure. “The Advance Notice will maintain strong value and choice for people with Medicare, continue our efforts to improve our programs, and fulfill our mandate to implement the Inflation Reduction Act effectively and efficiently.”

The Advance Notice proposes updates to MA payment growth rates and changes to the MA and Part D payment methodologies. These proposals include technical updates to the MA risk adjustment model to keep the model up to date and improve payment accuracy, such as by fully transitioning to the Internal Classification of Diseases (ICD)-10 system, which has been in use since 2015. In addition, CMS is seeking comment on MA quality measurement under Part C Star Ratings as part of CMS’s overarching efforts to align quality measures across federal programs and with private payers, reduce burden, and improve the effectiveness of quality programs.

“The commonsense proposals in the Advance Notice, coupled with the proposals in the MA and Part D rule released in December, ensure these important programs continue to meet the health care needs of all beneficiaries while improving the quality and long-term stability of the Medicare program,” said CMS Deputy Administrator and Director of the Center for Medicare Meena Seshamani, MD, Ph.D.

The Advance Notice is open for public comment, and comments must be submitted by March 3, 2023. The Medicare Advantage and Part D payment policies for 2024 will be finalized in the CY 2024 Rate Announcement, which will be published no later than April 3, 2023.

The 2024 Advance Notice may be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents and selecting “2024 Advance Notice.”

A fact sheet discussing the provisions of the Advance Notice can be viewed here: https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-advance-notice-fact-sheet

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Rural Emergency Hospitals (REHs) are a new provider type established by the Consolidated Appropriations Act, 2021 to address the growing concern over closures of rural hospitals. The REH designation provides an opportunity for Critical Access Hospitals (CAHs) and certain rural hospitals to avert potential closure and continue to provide essential services for the communities they serve. Conversion to an REH allows the facility to continue providing emergency services, observation care, and, if elected by the REH, additional medical and health outpatient services, that do not exceed an annual per patient average of 24 hours. The implementation of this new provider type, effective January 1, 2023, will promote equity in health care for those living in rural communities by facilitating access to needed services.

Rural Emergency Hospitals: Payment Policies

REHs are facilities that convert from either a critical access hospital (CAH) or a rural hospital (or one treated as such under section 1886(d)(8)(E) of the Social Security Act) with not more than 50 beds and that do not provide acute care inpatient services, with the exception of post-hospital extended care services furnished in a distinct part unit licensed as a skilled-nursing facility. In this rule, CMS is finalizing the provider enrollment procedures and payment rates that will apply to REHs. Along with the REH Conditions of Participation, the policies in this final rule will allow rural hospitals to seek this new designation and provide continued access to emergency services, observation care, and any additional outpatient services elected by the REH.

By statute, REH services include emergency department services and observation care and may include other outpatient medical and health services as specified by the Secretary.

To improve access to all types of care in rural settings, CMS is finalizing our proposal to broadly define “REH services” to include all covered outpatient department services (as defined in section 1833(t)(1)(B) of the Act (other than clause (ii) of such section)) when furnished by an REH. REHs will be paid for furnishing REH services at a rate that is equal to the OPPS payment rate, for the equivalent covered outpatient department service, increased by 5%. Beneficiaries will not be charged coinsurance on the additional 5% payment. CMS is also finalizing our proposal that REHs may provide outpatient services that are not otherwise paid under the OPPS (such as services paid under the Clinical Lab Fee Schedule), as well as post-hospital extended care services, furnished in a unit of the facility that is a distinct part of the facility licensed as a skilled nursing facility; however, these services will not be considered REH services and, therefore, will be paid under the applicable fee schedule for such services, and the facility will not receive the additional 5% payment increase that CMS will apply to REH services.

REHs will also receive a monthly facility payment. After the initial payment is established in CY 2023, the payment amount will increase in subsequent years by the hospital market basket percentage increase.

Rural Emergency Hospitals: Conditions of Participation

CMS has established Conditions of Participation (CoPs) to ensure the health and safety of patients who will receive REH services in the most efficient manner possible, while taking into consideration the access and quality of care needs of an REH’s patient population. The standards for REHs closely align with the current CAH CoPs in most cases, while accounting for the uniqueness of REHs and statutory requirements. In most instances, the REH policies also closely align to the current hospital and ambulatory surgical center standards, such as the polices for outpatient service requirements and the life safety code (LSC), respectively. The REH CoPs establish a full range of health and safety standards specific to governance, services offered, staffing, physical environment, and emergency preparedness. Specific requirements include:

• REHs must have a clinician on-call at all times and available on-site within 30 or 60 minutes depending on if the facility is located in a frontier area.
• The REH emergency department must be staffed 24 hours per day and seven days per week by an individual competent in the skills needed to address emergency medical care, and this individual must be able to receive patients and activate the appropriate medical resources to meet the care needed by the patient.
• REHs must develop, implement, and maintain an effective, ongoing, REH-wide, data-driven Quality Assurance and Performance Improvement (QAPI) program, and it must address outcome indicators related to staffing.
• The annual per-patient average length of stay cannot exceed 24 hours, in accordance with the statute, and the time calculation begins with the registration, check-in, or triage of the patient and ends with the discharge of the patient from the REH (which occurs when the physician or other appropriate clinician has signed the discharge order or at the time the outpatient service is completed and documented in the medical record).
• REHs must have an infection prevention and control and antibiotic stewardship program that adhere to nationally recognized guidelines.

Rural Emergency Hospital (REH) Provider Enrollment

Providers and suppliers are required to enroll in Medicare to receive payments for services and items furnished to Medicare beneficiaries. The purpose of the provider enrollment process is to help confirm that providers and suppliers seeking to bill Medicare meet all federal and state requirements to do so. We are finalizing our proposals to update our existing Medicare provider enrollment regulations in 42 CFR Part 424, subpart P, to address enrollment requirements for REHs. (Additional information regarding these requirements is included in the final rule’s preamble and will be included in future sub-regulatory guidance.) One of the most important REH enrollment provisions being finalized in the final rule is that the facility may submit a Form CMS-855A, change of information application (rather than an initial enrollment application), in order to convert from a CAH to an REH. CMS believes that not requiring an initial application, which generally takes longer for a Medicare Administrative Contractor (MAC) to process than a change of information application, will help expedite the CAH-to-REH conversion.

Rural Emergency Hospitals (REH) Physician Self-Referral Law Update

The physician self-referral law, commonly known as the “Stark Law”: (1) prohibits a physician from making referrals for certain designated health services payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless the requirements of an applicable exception are satisfied; and (2) prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third-party payer) for any improperly referred designated health services. A financial relationship may be an ownership or investment interest in the entity or a compensation arrangement with the entity. The statute establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.

In the CY 2023 OPPS/ASC final rule, CMS is finalizing revisions to certain existing exceptions to make them applicable to compensation arrangements to which an REH is a party. CMS is not finalizing the proposed exception for ownership or investment interests in an REH. However, the rural provider exception, which includes only limited statutory requirements to ensure that the physician self-referral law does not create a barrier to care for residents of rural areas, remains available to REHs.

Rural Emergency Hospital Quality Reporting (REHQR) Program

Section 1861(kkk)(7) of the Social Security Act, as added by section 125(a)(1)(B) of Division CC of the CAA, requires the Secretary to establish quality measurement reporting requirements for Rural Emergency Hospitals (REHs).

CMS is finalizing that, in order for REHs to participate in the REHQR Program, they must have an account with the Hospital Quality Reporting (HQR) secure portal and a designated Security Official (SO). CMS also sought comment on several measures under consideration for the new Rural Emergency Hospital Quality Reporting Program, as well as on topics of interest for the REHQR Program for future rulemaking, including rural emergency department services, rural behavioral and mental health, rural maternal health, rural telehealth services, and health equity.

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