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CMS Roundup (November 15, 2024)

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 Issues Calendar Year 2025 Final Payment Rules for Home Health and End-Stage Renal Disease Services *

November 1: CMS released the Calendar Year (CY) 2025 Home Health Prospective Payment System (PPS) final rule, an annual release that updates Medicare payment policies and rates for home health agencies. Details can be found here [ https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-home-health-prospective-payment-system-final-rule-fact-sheet-cms-1803-f ]. 

CMS also issued a final rule that sets the CY 2025 annual technical payment rate updates for the End-Stage Renal Disease (ESRD) PPS, for renal dialysis services furnished to people. Details can be found here [ https://www.cms.gov/newsroom/fact-sheets/calendar-year-2025-end-stage-renal-disease-esrd-prospective-payment-system-pps-final-rule-cms-1805-f ]. 

*CMS Kicks-Off Health Insurance Marketplace Open Enrollment Period*

November 1: CMS announced the start of the Health Insurance Marketplace Open Enrollment Period on Healthcare.gov [ https://www.healthcare.gov/blog/apply-for-marketplace-insurance-today/ ]. Open enrollment runs from November 1, 2024, to January 15, 2025. Consumers who enroll by midnight December 15 can get full-year coverage that starts January 1, 2025. Consumers who enroll after December 15 but before the deadline on January 15 will have coverage that begins February 1, 2025.

*New Webpage & Blog Share Updates on the Work of the Organ Transplant Affinity Group *

November 8: HHS, in collaboration with CMS and the Health Resources and Services Administration (HRSA), launched a new webpage [ https://www.hhs.gov/about/agencies/advisory-committees/organ-transplantation-affinity-group/index.html ] to share updates on the work of the Organ Transplant Affinity Group (OTAG). Led by CMS and HRSA, OTAG is driving collaborative improvements in organ donations, clinical outcomes of transplantation, system improvement, quality measurement, transparency, and regulatory oversight.

On November 12, CMS and HRSA jointly released a blog [ https://www.hhs.gov/blog/2024/11/12/how-were-making-organ-transplant-system-safe-equitable.html ] offering additional details on OTAG’s progress toward producing impactful outcomes and demonstrating value in support of HHS' Strategic Initiatives, including enhanced efforts in coordinating federal policy development, integrating  federal organ transplantation-related initiatives and activities, and overall improvement of the national organ transplantation system performance*.*

*CMS Releases Supplemental Evaluation Report for the Oncology Care Model*

November 8: CMS released Evaluation of the Oncology Care Model, Impacts by Risk Arrangement [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ocm-tot-report ]. The  Oncology Care Model [ https://www.cms.gov/priorities/innovation/innovation-models/oncology-care ] (OCM) is designed to improve the costs and quality of oncology care through payments for monthly enhanced oncology services and financial performance. The report shows that practices that adopted two-sided risk drove payment reductions in OCM and achieved net savings in 10 of 11 performance periods, totaling $229.6 million. 

*CMS Announces Medicare A & B Premiums, Deductibles, and Coinsurance for 2025*

November 8: CMS announced the Medicare Part A and Part B premiums, deductibles, and coinsurance amounts for 2025, as well as the 2025 Medicare Part D income-related monthly adjustment amounts. The standard monthly premium for Medicare Part B will be $185.00 in 2025, an increase of $10.30 (5.9%) from the standard monthly premium of $174.70 in 2024.

The percentage increase in the 2025 standard premium is the same as the increase in the 2024 premium. The Medicare Part A inpatient hospital deductible that people with Medicare pay if admitted to the hospital will be $1,676 in 2025, an increase of $44 from $1,632 in 2024. Details are in this fact sheet [ https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles ].

*CMS Releases Report on Rural-Urban Health Disparities in Medicare*

November 12: CMS released a report [ https://www.cms.gov/files/document/rural-urban-disparities-health-care-medicare-2024.pdf ], "Rural-Urban Disparities in Health Care in Medicare", in recognition of National Rural Health Month. The report presents information on the quality of health care received by people with Medicare nationwide, highlighting (1) rural-urban differences in health care experiences and clinical care, (2) how rural-urban differences in health care experiences and clinical care vary by race and ethnicity, and (3) historical trends in quality of care for rural and urban residents. 

*CMS & Federal Transit Administration Release Medicaid Transportation Coverage & Coordination Fact Sheet*

November 12: CMS, in collaboration with the Federal Transit Administration, released the Medicaid Transportation Coverage and Coordination fact sheet [ https://www.medicaid.gov/medicaid/benefits/downloads/ccam-medicaid-trans-coverage-coord-factsheet.pdf ]. The fact sheet helps guide transportation partnerships between state Medicaid agencies, state departments of transportation, and other transportation entities that provide, or are exploring, Medicaid-funded non-emergency medical transportation. The information builds on CMS’ Medicaid Transportation Coverage Guide [ https://www.medicaid.gov/sites/default/files/2023-09/smd23006.pdf ] released in 2023 and includes commonly asked questions and relevant resources. 

*CMS Publishes White Paper on Reimagining Rural Health *

November 12: CMS published a white paper [ https://www.cms.gov/files/document/reimagining-rural-health-strategy.pdf ], “Re-imagining Rural Health: Themes, Concepts, and Next Steps from the Center for Medicare and Medicaid Innovation* *‘Hackathon’ Series.” The paper offers recommendations and potential next steps for addressing health challenges in rural communities, building on valuable insights from previous Innovation Center work and lessons learned from the CMS 2024 Rural Health Hackathon [ https://www.cms.gov/priorities/innovation/2024-rural-health-hackathon ].

*CMS Accountable Health Communities Model Report Shows Reduced Spending, ER Visits & Hospital Admissions*

November 12: CMS released the Third Evaluation Report of the Accountable Health Communities Model [ https://www.cms.gov/priorities/innovation/data-and-reports/2024/ahc-3rd-eval-report ]. The model, which ended in 2023, tested whether connecting people to community resources for their health-related social needs (HRSNs) improved quality of care outcomes and reduced costs. The model screened all people with Medicare and Medicaid for core HRSNs. Forty percent of those who received navigation services had at least one HRSN resolved, including 28% who had all their needs resolved. The report shows how the model decreased Medicare and Medicaid spending for people and reduced emergency department visits and inpatient admissions. 

*CMS Publishes Materials on its Patient Safety Strategy*

November 13: Illustrating its commitment to patient safety and in the wake of Health Care Quality Week, CMS published materials on CMS' patient safety strategy. Materials include a fact sheet [ https://www.cms.gov/files/document/cms-national-quality-strategy-fact-sheet.pdf ] outlining key actions to date on CMS’ National Quality Strategy [ https://www.cms.gov/medicare/quality/meaningful-measures-initiative/cms-quality-strategy ] and an information sheet [ https://www.cms.gov/files/document/advancing-health-care-safety-all.pdf ] on CMS’ Patient Safety for All strategy.

*CMS Announces Funding Opportunity for States to Update Essential Health Benefits Benchmark Plans*

November 13: CMS announced the Essential Health Benefits (EHB)-Benchmark Plan Modernization Grant for States with a Federally-facilitated Exchange (FFE) Notice of Funding Opportunity (NOFO), available at Grants.gov [ https://www.grants.gov/search-results-detail/356740 ]. The grants would fund states' efforts to review and potentially modernize their EHB benchmark plans due to enrollees experiencing difficulty accessing needed services, changes in medical evidence or scientific advancement, changes in the health needs of their populations, or other clinical considerations. To be eligible for funding, the state must have an FFE as of January 1, 2026. CMS anticipates awarding at least $250,000 per state to complete this work, with an additional $125,000 award per applicant who decides to establish an advisory board as part of their project. 

*Local Coverage Determination Issued for Treatment of Diabetic Foot and Venous Leg Ulcers *

November 14: CMS Medicare Administrative Contractors issued a “Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers (DFUs) and Venous Leg Ulcers (VLUs)” local coverage determination (LCD). This final LCD establishes when it is reasonable and necessary to use skin substitute grafts to treat patients with DFUs and VLUs. The LCD does not address other types of wounds. Details can be found here [ https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39828&ver=6 ].

*CMS Posts Key Concepts Focused on Quality of Care & Multi-Payer Alignment*

CMS recently posted two new Key Concepts, one focusing on Quality of Care [ https://www.cms.gov/priorities/innovation/key-concepts/quality-care ] and another on Multi-Payer Alignment [ https://www.cms.gov/priorities/innovation/key-concepts/multi-payer-alignment#:~:text=Defining%20key%20terms%3A&text=Multi%2DPayer%20Alignment%3A%20Refers%20to,care%20and%20reducing%20administrative%20burden ]. Written for non-technical stakeholders, such as those who are new to the health care field or the interested public, Key Concepts [ https://www.cms.gov/priorities/innovation/key-concepts ] are brief introductions using everyday language to describe topics and concepts critical to CMS’ effort to transform the health care system through the Innovation Center [ https://www.cms.gov/priorities/innovation/overview ]. The Innovation Center works toward a vision of a health system that achieves equitable outcomes through high-quality, affordable, person-centered care.

*Other Recent Releases: *

 November 1: CMS Announces New Policies to Reduce Maternal Mortality, Increase Access to Care, and Advance Health Equity [ https://www.cms.gov/newsroom/press-releases/cms-announces-new-policies-reduce-maternal-mortality-increase-access-care-and-advance-health-equity ]

November 1: HHS Finalizes Physician Payment Rule Strengthening Person-Centered Care and Health Quality Measures [ https://www.cms.gov/newsroom/press-releases/hhs-finalizes-physician-payment-rule-strengthening-person-centered-care-and-health-quality-measures ]

November 14: Biden-Harris Administration Announces Approvals in Five States that will Keep Eligible Children and Adults Enrolled in Medicaid and CHIP [ https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-approvals-five-states-will-keep-eligible-children-and-adults ] 

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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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