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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: State Medicaid IT Expenditures to Improve Mental Health/SUD Treatment May Qualify for Enhanced Federal Matching Funds*

June 14: CMS released an informational bulletin [ https://www.medicaid.gov/federal-policy-guidance/downloads/cib06142024.pdf ] highlighting examples of state Medicaid expenditures for information technology, that may qualify for enhanced federal matching rates for administrative costs, relating to improving mental health and/or substance use disorder treatment and support services for people with Medicaid. The informational bulletin also reminds states how to apply for this enhanced administrative match and includes details on additional requirements and limitations in regulations and guidance.

*CMS Releases Third Annual Evaluation Report on Maternal Opioid Misuse Model*

June 17: CMS released the third annual Maternal Opioid Misuse (MOM) Model evaluation report [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-rpt ]. The MOM Model [ https://www.cms.gov/priorities/innovation/innovation-models/maternal-opioid-misuse-model ] aims to address care fragmentation, quality of care, and costs in the care of pregnant and postpartum people with opioid use disorder who are enrolled in Medicaid through the transformation of state-driven care delivery systems. The report found that states have implemented evidence-based opioid use disorder treatment practices, anti-stigma equity initiatives, and fully integrated peer recovery coaches into care practices without fundamentally altering existing Medicaid benefits, resulting in patients reporting positive care experiences. Still, awardees encounter several implementation challenges, including low enrollment, barriers to health-related social needs care, and stigma. A two-page “At-A-Glance” summary can be found here [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/mom-third-ann-eval-aag-rpt ].

*CMS Posts Updated Roadmap to Better Care for American Indians and Alaska Natives*

June 17: CMS released a newly updated Coverage to Care (C2C) Roadmap to Better Care: Tribal Version [ https://www.cms.gov/files/document/better-care-tribal-interactive-v3.pdf ], to better address the specific health needs of American Indians and Alaska Natives. The guide includes a new introduction detailing the unique health protections in place for American Indians and Alaska Natives as well as an updated glossary of terms, important links, and contact information.

*CMS Releases Grants, Toolkit, to Help States Expand Critical School-Based Health Services *

June 25: CMS announced the awarding of $50 million in School-Based Services (SBS) Implementation, Enhancement, and Expansion grants [ https://www.medicaid.gov/resources-for-states/medicaid-state-technical-assistance/medicaid-and-school-based-services/index.html#awards ]  to 18 states. The grants provide each state at least $2.5 million to help schools connect millions of children to critical health services, particularly for mental health, through Medicaid and the Children’s Health Insurance Program (CHIP).

In a related action, CMS also released the SBS Readiness Checklist Tool [ https://www.medicaid.gov/resources-for-states/downloads/readiness-checklist-tool.xlsx ]. This tool was developed to help state Medicaid agencies draft an SBS state plan amendment, adopt certain flexibilities, and generally assist in the process of working with CMS to reimburse for SBS.

*CMS Posts New FAQs on the National Coverage Determination for PrEP*

June 25: CMS posted a new FAQ [ https://www.cms.gov/files/document/faq-prep-hiv-06242024.pdf ]  document related to the National Coverage Determination (NCD) for Pre-exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV Infection. The FAQ was created based on public feedback asking that more technical information for submitting future Medicare Part B claims for PrEP for HIV be released in advance of the final NCD.

*CMS Releases Notice of Funding Opportunity for Transforming Maternal Health Model*

June 26: CMS released the Notice of Funding Opportunity [ https://grants.gov/search-results-detail/354874 ] (NOFO) application for the Transforming Maternal Health (TMaH) Model [ https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model ]. The model’s primary focus is improving health outcomes for mothers and their infants enrolled in Medicaid and Childrens’ Health Insurance Program (CHIP). Under TMaH, selected state Medicaid agencies will receive targeted technical support with the goal of developing a whole-person approach to pregnancy, childbirth, and postpartum care. CMS will issue Cooperative Agreements to up to 15 state Medicaid agencies. Applications are due September 20, 2024, and resources to support states in developing their applications are available on the TMaH Model webpage [ https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model ].

*CMS Releases Calendar Year 2025 Home Health Prospective Payment System Proposed Rule*

June 26: CMS released the calendar year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which updates Medicare payment policies and rates for home health agencies. In addition, there are proposed changes to the wage index, updates to data collection and reporting, conditions of participation, provider enrollment, and more. Details can be found in the fact sheet [ https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-home-health-prospective-payment-system-proposed-rule-fact-sheet-cms-1803-p ]. The proposed rule is posted to the Federal Register here [ https://www.federalregister.gov/public-inspection/2024-14254/medicare-program-calendar-year-2025-home-health-prospective-payment-system-rate-update-home-health ], with comments due August 26, 2024.

*CMS Issues Calendar Year 2025 End-Stage Renal Disease Prospective Payment System Proposed Rule *

June 27: CMS issued the CY 2025 proposed rule to update payment rates under the end-stage renal disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) Prospective Payment System (PPS) for renal dialysis services. This rule also proposes a new methodology for calculating an ESRD PPS-specific wage index using data from the Bureau of Labor Statistics, which would be used to adjust ESRD PPS payments for geographic differences in area wages. The rule also proposes changes to the low-volume payment adjustment methodology. Additionally, this rule proposes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities and proposes to expand payment for AKI dialysis in the home setting. Lastly, this rule discusses operational considerations around the inclusion of oral-only drugs into the ESRD PPS beginning January 1, 2025, and proposes to update requirements for the ESRD Quality Incentive Program. Details can be found on the here [ https://www.cms.gov/newsroom/fact-sheets/calendar-year-2025-end-stage-renal-disease-esrd-prospective-payment-system-pps-proposed-rule-cms ]. The proposed rule is posted to the Federal Register here [ https://www.federalregister.gov/public-inspection/2024-14359/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis ], with comments due August 26, 2024.

*Other Recent Releases: *

June 17:  CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack [ https://www.cms.gov/newsroom/press-releases/cms-preparing-close-program-addressed-medicare-funding-issues-resulting-change-healthcare-cyber ]

June 17: Federal Study Examines Care Following Nonfatal Overdose Among Medicare Beneficiaries; Identifies Effective Interventions and Gaps in Care [ https://www.cms.gov/newsroom/press-releases/federal-study-examines-care-following-nonfatal-overdose-among-medicare-beneficiaries-identifies ]

 June 24: HHS Finalizes Rule Establishing Disincentives for Health Care Providers That Have Committed Information Blocking [ https://www.hhs.gov/about/news/2024/06/24/hhs-finalizes-rule-establishing-disincentives-health-care-providers-that-have-committed-information-blocking.html ]

June 26: _ _HHS Announces Cost Savings for 64 Prescription Drugs Thanks to the Medicare Rebate Program Established by the Biden-Harris Administration’s Lower Cost Prescription Drug Law [ https://www.cms.gov/newsroom/press-releases/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-rebate-program-established-biden ]

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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.

 

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