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CMS Issues Calendar Year 2024 Home Health Prospective Payment System Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule. The proposed rule updates Medicare payment policies and rates for Home Health Agencies (HHAs) and other . Estimated Medicare payments to HHAs in CY 2024 would decrease in the aggregate by 2.2 percent, or $375 million compared to CY 2023, based on the proposed policies. The proposed rule also adds new quality reporting program measures, including a measure on the percent of patients/residents who are up to date with the COVID-19 vaccine, and proposes certain technical changes....

Short URL: http://www.advancingstates.org/node/74805

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CMS Releases 2024 Projected Medicare Part D Premium and Bid Information

CMS projects the calendar year 2024 average total monthly premium for Medicare Part D prescription drug coverage to be $55.40; a decrease of 1.8 percent from 2023. The average total Part D premium is the sum of the average basic premium and the average supplemental premium for plans with enhanced coverage. CMS reports that the projected decrease in the average total Part D premium is due to a limit in the growth of the base beneficiary premium to an annual six percent increase and other changes to the Part D benefit in 2024 as specified by the Inflation Reduction Act. Additionally, in 2024 CMS’ Part D pharmacy price concessions policy is expected to reduce beneficiary out-of-pocket costs by requiring Part D plans to apply all price...

Short URL: http://www.advancingstates.org/node/74785

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CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP)

On Monday, July 31, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of April 2023, over 65.8 million people are enrolled in Medicare; more than 33.9 million are enrolled in fee-for-service Medicare and more than 31.9 have a Medicare Advantage plan. Over 94.1 million enrollees have Medicaid and CHIP; more than 87 million individuals have Medicaid and nearly 7.1 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs...

Short URL: http://www.advancingstates.org/node/74784

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Extension of 1915(c) Home and Community-Based Services Waiver Appendix K Expiration Dates

This week, the Centers for Medicare & Medicaid Services (CMS) announced that Appendix K flexibilities currently scheduled to end on Nov. 11, 2023 may be extended, if a state takes action by Nov. 11, 2023 to permanently incorporate desired Appendix K provisions into their 1915(c) programs. The applicable Appendix K flexibilities will remain in place until the effective date of the 1915(c) waiver amendment or renewal...

Short URL: http://www.advancingstates.org/node/74783

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CMS Announces New Dementia Care Model

This week, CMS announced its Guiding an Improved Dementia Experience (GUIDE) Model, which aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through care coordination and management, caregiver support, and respite services. Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. The intended beneficiary population is community-dwelling Medicare fee-for-service beneficiaries, including beneficiaries dually eligible for Medicare...

Short URL: http://www.advancingstates.org/node/74782

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CMS Releases Calendar Year (CY) 2024 Medicare Proposed Payment Rules

On July 13th, CMS published several proposed CY 2024 physician and hospital Medicare payment rules with comments due on September 11, 2023. The proposed rules are: CY 2024 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1786-P). CMS proposes updating OPPS payment rates for hospitals that meet applicable quality reporting requirements by 2.8%....

Short URL: http://www.advancingstates.org/node/74759

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Expanded Report to Congress, Non-Emergency Medical Transportation in Medicaid, 2018–2021

The Centers for Medicare & Medicaid Services (CMS) posted an expanded Report to Congress for Non-Emergency Medical Transportation (NEMT) in Medicaid. This new report supplies data from the Transformed Medicaid Statistical Information System (T-MSIS) from 2018-2021. This report provides a detailed analysis of Medicaid coverage of NEMT such as the types of medical services accessed when using NEMT by beneficiary subgroup, a comparison by delivery model of the volume of NEMT services used by states, and monthly trends in the use of NEMT versus telehealth services.

Short URL: http://www.advancingstates.org/node/74729

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Notice with Comment - Transitional Coverage for Emerging Technologies (CMS-3421-NC)

CMS issued a proposed procedural notice on June 22nd that describes a new Medicare coverage pathway to achieve more timely and predictable access to new medical technologies for people with Medicare. The new Transitional Coverage for Emerging Technologies (TCET) pathway for Breakthrough Devices uses current national coverage determination and coverage with evidence development processes to expedite Medicare coverage of certain Breakthrough Devices. The TCET pathway is intended to balance multiple considerations when making coverage determinations: (1) facilitating early, predictable, and safe beneficiary access to new technologies; (2) reducing manufacturers’ and innovators’ uncertainty about coverage...

Short URL: http://www.advancingstates.org/node/74698

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Guidance on Mandatory Coverage Requirements for Adult Vaccines

On June 27th, the Centers for Medicare & Medicaid Services (CMS) released guidance to states, outlining new mandatory coverage requirements for approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and their administration, without cost sharing. Starting from October 1, 2023, as mandated by the Inflation Reduction Act (IRA), Medicaid and Children's Health Insurance Program (CHIP) must provide coverage and payment for these services. The guidance also specifies the requirements for states to claim a one percentage point increase in the federal medical assistance percentage (FMAP) for these services.

Short URL: http://www.advancingstates.org/node/74697

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CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP)

On Tuesday, June 29, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of March 2023, over 65.7 million people are enrolled in Medicare; nearly 34 million are enrolled in fee-for-service Medicare and more than 31.7 have a Medicare Advantage plan. Over 93.8 million enrollees have Medicaid and CHIP; more than 86.7 million individuals have Medicaid and more than 7.1 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

Short URL: http://www.advancingstates.org/node/74696

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