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Centers for Medicare & Medicaid ServicesCMS Roundup

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

*CMS Publishes Fact Sheet on Services Available Through GUIDE Model*

July 29: CMS published a fact sheet [ https://www.cms.gov/files/document/guide-model-patient-caregiver-fs.pdf ] about the services available through the Guiding an Improved Dementia Experience (GUIDE) Model [ https://www.cms.gov/priorities/innovation/innovation-models/guide ], along with guidance on how people with Medicare can work with their doctor to access GUIDE services and supports. GUIDE focuses on dementia care management and aims to improve quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities.

*CMS Approves North Carolina Plan to Incentivize Medical Debt Relief*

July 26: CMS approved the North Carolina Department of Health and Human Services’ plan to use the state's Medicaid program to incentivize hospitals to relieve more than a decade of existing medical debt for eligible North Carolinians and prevent accumulation of new debt going forward. The plan has the potential to relieve a potential $4 billion in existing medical debt. Hospitals that choose to participate and meet the eligibility requirements will receive a higher level of Medicaid reimbursement under the Healthcare Access and Stabilization Program (HASP). Vice President Kamala Harris recently applauded North Carolina’s efforts. See the full statement here [ https://www.whitehouse.gov/briefing-room/statements-releases/2024/07/29/statement-from-vice-president-kamala-harris-on-north-carolinas-medical-debt-announcement/#:~:text=That%20is%20why%20President%20Biden,breaking%20vote%20in%20the%20Senate ].

*CMS Extends Accountable Care Organization Primary Care Flex Model Application Submission Period*

July 26: CMS extended the application submission period for the Accountable Care Organization Primary Care Flex (ACO PC Flex [ https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model ]) Model until August 23, 2024 at 11:59pm EST. The previous deadline for submission was August 1, 2024. This change has no impact on existing Shared Savings Program application actions and deadlines. The ACO PC Flex Model is a new primary care payment model for low-revenue ACOs in the Shared Savings Program that aims to increase primary care funding and flexibility.

*Delaware State Innovation Waiver Extension Approved Through 2029*

July 30: The U.S. Department of Health and Human Services and the U.S. Department of the Treasury approved Delaware’s application to extend its State Innovation Waiver known as the Delaware Health Insurance Individual Market Stabilization Reinsurance Program under section 1332 of the Affordable Care Act for an additional five years from Plan Years 2025 through 2029. The waiver extension means Delaware will continue its state-based reinsurance program, which is projected to lower individual market premiums and results in more consumers in the state being covered. Information can be found on this fact sheet [ https://www.cms.gov/files/document/1332-de-extension-fact-sheet.pdf ].

*CMS Approves Nevada’s Plan for Mobile Crises Services for Individuals with Medicaid*

July 30: CMS approved a state plan amendment [ https://www.medicaid.gov/medicaid/spa/downloads/NV-22-0005.pdf ] (SPA) for mobile crisis services in Nevada. Authorized under President Biden’s American Rescue Plan (ARP), states have the ability to support community-based mobile crisis intervention services for individuals with Medicaid. Mobile crisis intervention services are essential tools to meet people in crisis where they are and rapidly provide critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option helps states integrate these services into their Medicaid programs, a critical component in establishing a sustainable public health-focused support network. This is the 19th mobile crisis SPA approved. 

*CMS Finalizes Fiscal Year (FY) 2025 Medicare Payment Policies for Hospice, Inpatient Rehabilitation, Inpatient Psychiatric, and Skilled Nursing Facilities*

July 30: CMS issued the FY 2025 Hospice Wage Index and Payment Rate Update Final Rule (CMS-1810-F). This rule sets routine updates to hospice payments and the aggregate cap amount for FY 2025 in accordance with existing statutory and regulatory requirements. Details are in the fact sheet [ https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2025-hospice-payment-rate-update-final-rule-cms-1810-f ].

July 31: CMS issued the FY 2025 Inpatient Rehabilitation Facilities Prospective Payment System (IRF IPPS) final rule (CMS-1804-F). This rule updates Medicare payment policies and rates under the IRF PPS and IRF Quality Reporting Program for FY 2025. Details are in the fact sheet [ https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-inpatient-rehabilitation-facility-prospective-payment-system-final-rule-cms-1804-f ].

July 31: CMS issued the FY 2025 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Quality Reporting Updates final rule (CMS-1806-F). This rule updates Medicare payment policies and rates under the IPF PPS and IPF Quality Reporting Program for FY 2025. Details are in the fact sheet [ https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-medicare-inpatient-psychiatric-facilities-prospective-payment-system-ipf-pps-and-0 ].

July 31: CMS issued the FY 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule (CMS-1802-F). This final rule updates Medicare payment policies and rates for SNFs under SNF PPS for FY 2025. Details are in the fact sheet [ https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-skilled-nursing-facility-prospective-payment-system-final-rule-cms-1802-f ].

*CMS Announces New Coverage Pathway for New Medical Technologies*

August 7: CMS announced a new Medicare coverage pathway to achieve more timely and predictable access to new medical technologies for people with Medicare. The Transitional Coverage for Emerging Technologies (TCET) pathway for breakthrough devices supports improved care and innovation by providing a clear, transparent, and consistent coverage process while maintaining safeguards for the Medicare population. In addition, CMS issued an updated Coverage with Evidence Development guidance document and National Coverage Analysis Evidence Review guidance. Details are available on this fact sheet [ https://www.cms.gov/newsroom/fact-sheets/final-notice-transitional-coverage-emerging-technologies-cms-3421-fn ].

*CMS Issues New Medicaid Guidance on Family Planning Services*

August 8: CMS released guidance [ https://www.medicaid.gov/federal-policy-guidance/downloads/cib08082024.pdf ] on how state Medicaid agencies must ensure that enrollees have access to family planning services. This bulletin highlights state obligations, provides strategies to enhance access to contraception, provides guidance on confidentiality requirements for those seeking family planning services, and shares recommendations about ways to measure quality in delivering family planning services. 

*Other Recent Releases: *

July 29: CMS Releases Preliminary 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration [ https://www.cms.gov/newsroom/news-alert/cms-releases-preliminary-2025-medicare-part-d-bid-information-and-announces-premium-stabilization ]

August 1: HHS Finalizes New Policies to Support Underserved Communities, Mitigate Drug Shortages, and Promote Safety [ https://www.cms.gov/newsroom/press-releases/hhs-finalizes-new-policies-support-underserved-communities-mitigate-drug-shortages-and-promote ]

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CMS, an agency within the U.S. Department of Health and Human Services, serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. The agency protects public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and the Health Insurance Marketplace.

 

Get CMS news at cms.gov/newsroom [ https://www.cms.gov/newsroom ], sign up for CMS news via email [ https://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/EmailUpdates ], and follow CMS on Twitter @CMSgov [ https://twitter.com/cmsgov ]







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