The Centers for Medicare and Medicaid Services (CMS) announced the Advance Notice of Methodological Changes for Contract Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (press release, fact sheet and FAQs) What it is. The Advance Notice addresses a wide array of MA and Part D-related policies and includes the estimated… (Slifer, January 31, 2024) #Medicare Advantage, #Medicare Part D, #Prescription Drugs, #Quality, #Risk Adjustment, #Risk Corridors

The Department of Health and Human Services (HHS) announced a series of actions to address the surging syphilis epidemic, reaching its highest levels since the 1950s. With 207,255 reported cases in 2022, an 80 percent increase since 2018, and over 3,700 cases of congenital syphilis according to a new Centers for Disease Control and Prevention (CDC) report, HHS is focusing on targeted measures to… (Colocho, January 31, 2024) #Care Coordination, #Health Equity, #Prevention, #Public Health

On Monday, CMS released an FAQs regarding the implementation of 12-month postpartum Medicaid coverage.  The document includes details regarding what constitutes full benefits during the 12-month extended postpartum eligibility period, defines enhanced pregnancy-related services, outlines the mandatory tobacco cessation benefit for pregnant persons, and clarifies when a state plan amendment (SPA) is needed to amend coverage.   Of note, Texas… (Joyce, January 30, 2024) #Health Equity, #Prevention, #Primary Care, #Public Health, #Women’s Health

The Center for Medicare and Medicaid Innovation (CMMI) officially announced the Cell and Gene Therapy (CGT) Access Model, with sickle cell disease as the initial focus of the model (fact sheet, FAQs) The model is pursuant to President Biden’s executive order entitled “Lowering Prescription Drug Costs for Americans and, subsequently, CMMI’s February 2023 report detailing three potential models to be… (Slifer, January 30, 2024) #Demonstration Programs, #Drug Pricing, #Prescription Drugs

The Centers for Medicare & Medicaid Services (CMS) announced participation data for accountable care organization (ACO) initiatives in 2024. CMS reports that about 13.7 million people with Traditional Medicare are aligned to an ACO in 2024, which is a three percent increase since 2023 and represents nearly half of Traditional Medicare beneficiaries. The press release emphasizes that ACOs have been shown to have… (McClurg, January 29, 2024) #Accountable Care Organizations, #Health Equity, #Rural Health

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a panel focused on policies and activities related to the public health emergency, particularly highlighting a crucial provision in the American Rescue Plan Act (ARPA) that provided states with additional financial resources for investments in home- and community-based services (HCBS). MACPAC has been actively monitoring federal and state activities supporting this ARPA investment… (Colocho, January 29, 2024) #Budget, #Costs, #COVID-19, #Home Health, #Public Health, #Quality, #Transparency, #Workforce

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to discuss key themes derived from interviews with key stakeholders regarding state Medicaid agency contracts (SMACs). The Commissioner’s discussion will inform future policy options to be presented at the March meeting. Background. Staff explained how Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) are tailored to meet the unique needs of… (Colocho, January 26, 2024) #Care Coordination, #Dual Eligibles, #Quality, #Special Needs Plans

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to examine policy options for improving the transparency of Medicaid financing. Principal Analyst Rob Nelb explained how  the Medicaid statute allows states to fund the non-federal portion of Medicaid spending through various means, such as state general funds, health care-related taxes (provider taxes), intergovernmental transfers (IGTs), and certified public expenditures (CPEs)…. (Colocho, January 26, 2024) #Costs, #Hospitals, #Physicians, #Transparency

The Medicaid and CHIP Payment and Access Commission (MACPAC) met to vote on updated recommendations to improve the managed care appeals process to be included in the March 2024 report to Congress. All of the recommendations were approved, but some commissioners disagreed that recommendation 2.1 is necessary following the Commission’s discussion about the draft recommendations yesterday (Impact summary). Recommendation 2.1 To bring… (McClurg, January 26, 2024) #Program Integrity, #Quality

The Medicaid and CHIP Payment and Access Commission (MACPAC) held a discussion about the findings from an expert roundtable on the effect of Medicaid payment changes on beneficiary access to physician services. The themes of this discussion will inform future MACPAC research. Background. Staff began by recognizing the common conception that physicians are less likely to serve patients covered by Medicaid than those… (McClurg, January 26, 2024) #Health Equity, #Physicians