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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 Launches Campaign to Increase Nursing Home Staffing by Nursing Professionals*

December 16: CMS launched a national Nursing Home Staffing Campaign [ https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/nursing-home-staffing-campaign ], aimed at increasing the number of nurses working in nursing homes and at the state agencies that inspect nursing homes for compliance with CMS’ health and safety standards, with the goal of improving and protecting residents’ health and safety. The campaign is in response to feedback from nursing home staff and residents highlighting staffing as their primary concern. The campaign’s efforts include highlighting nursing home careers [ https://www.cms.gov/priorities/key-initiatives/nursing-home-careers ] available for nursing professionals at all staffing levels.

*CMS Details Early Lessons Learned from Acute Hospital Care at Home Initiative*

December 17: CMS posted a blog [ https://www.cms.gov/blog/lessons-cms-acute-hospital-care-home-initiative ] describing early lessons learned on quality, cost, and care experiences that have begun to inform the future of CMS’ Acute Hospital Care at Home (AHCAH) initiative and related efforts in the field. Early lessons from the AHCAH initiative suggest that providers can deliver safe, quality inpatient care in home settings for appropriately selected patients. Important questions remain, and CMS is exploring opportunities to answer these questions.

*CMS Highlights Information for Pharmacies and Dispensing Entities on Medicare Transaction Facilitator System *

December 17: CMS posted a new webpage [ https://www.cms.gov/inflation-reduction-act-and-medicare/medicare-drug-price-negotiation/resources-pharmacies-and-dispensing-entities ] providing pharmacies and other dispensing entities with resources for engaging with the new Medicare Transaction Facilitator (MTF) system. The MTF will be used to ensure that the negotiated prices for drugs in the Medicare Drug Price Negotiation Program [ https://www.cms.gov/inflation-reduction-act-and-medicare/medicare-drug-price-negotiation ] are applied at the point of sale, a core component of implementing the Medicare Drug Price Negotiation Program. The webpage includes an overview, frequently asked questions, and timelines for pharmacies.

*CMS Announces 2025 Health Equity Conference; Call for Proposals Now Open*

December 18: CMS will host the 2025 CMS Health Equity Conference [ https://www.cmshealthequitycon.com/index.html ]: Building a Healthier America on April 23-24, 2025. The free, hybrid conference will be held at the Hyatt Regency Hotel in Bethesda, Maryland, and will be available virtually. Attendees will hear about updates to CMS programs, explore the latest research, and collaborate on community engagement strategies. CMS is now accepting proposals for breakout session speakers and poster presenters. Community organizations, academics, researchers, and others are invited to submit proposals by 5 p.m. PT on Tuesday, January 21, 2025. To learn about proposal guidelines and how to submit work, there is a Call for Proposals webinar on January 14 at 2 p.m. ET. Additional Information on the Call for Proposals and a link to the webinar registration can be found here [ https://www.cmshealthequitycon.com/proposals.html ].

*CMS Releases National Health Expenditures Report Showing Growth in Health Care Spending and Strong Growth in Health Insurance Coverage*

December 18: The CMS Office of the Actuary (OACT) released the 2023 National Health Expenditures (NHE) Report. The report shows that U.S. health care spending grew 7.5% to reach $4.9 trillion in 2023, faster than the increase of 4.6% in 2022. The faster growth in 2023 reflected increased use of health care goods and services, including strong growth in private health insurance and Medicare. The insured share of the population reached 92.5%, as enrollment in private health insurance increased at a strong rate, and Medicaid enrollment remained at a relatively high level in 2023. Details, including highlights and infographics [ https://www.cms.gov/files/document/nhe-infographic.pdf ], can be found here [ https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical ]. The report is also covered in Health Affairs [ https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.01375 ].

*CMS Selects Four States to Participate in the Innovation in Behavioral Health Model*

December 18: CMS announced that four states, Michigan, New York, Oklahoma, and South Carolina, were selected to participate in the Innovation in Behavioral Health Model [ https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model ] (IBH). The IBH Model is focused on improving the quality of care and behavioral and physical health outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance use disorder (SUD). Additional information is available on this FAQ [ https://www.cms.gov/innovation-behavioral-health-ibh-model-frequently-asked-questions ].

*CMS Posts Proposed National Coverage Determination for Transcatheter Tricuspid Valve Replacement*

December 19: CMS posted a proposed National Coverage Determination (NCD) for Transcatheter Tricuspid Valve Replacement [ https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=314&doctype=NCA&timeframe=90&sortBy=updated&bc=20 ]. NCDs are made through an evidence-based process with multiple opportunities for public participation. CMS evaluates the quality of individual clinical studies, the degree to which the item or service improves health outcomes, and assesses the overall consistency of the entire body of evidence. The evidence considered must be generalizable to the Medicare population. NCDs are posted on the CMS Medicare Coverage Center [ https://www.cms.gov/medicare/coverage/center ] website, and interested parties are provided with the Medicare coverage criteria for each technology, a summary of the evidence considered, and CMS’ rationale for the decision.

*CMS Seeking Input on Medicare Beneficiary Identifier (MBI) Lookup Tools and Preventing MBI Theft and Misuse*

December 19: CMS seeks input and information from interested parties on approaches to prevent Medicare Beneficiary Identifier (MBI) theft and misuse. CMS is seeking information on both CMS-controlled and externally-controlled options for MBI Lookup Tools. Submitters are requested to share information on safeguards or best practices from inside or outside health care that CMS should consider for preventing MBI theft and misuse. Online submissions [ https://surveys.cms.gov/jfe/form/SV_3vCEXjQsqrdczKS ] are due by February 17, 2025.

*CMS Releases Data on the Experiences & Health of Women in the Medicare Program*

December 20: In collaboration with the White House Gender Policy Council, CMS released its first-ever Women's Health Data Book [ https://www.cms.gov/data-research/research/medicare-current-beneficiary-survey/data-briefs-tutorials/mcbs-2022-womens-health-data-book-and-executive-summary ] on the experiences of women in the Medicare program and an accompanying public use file [ https://www.cms.gov/data-research/research/medicare-current-beneficiary-survey/data-tables/2022-socio-demographic-and-health-characteristics-medicare-beneficiaries-sex-puf ]. This data book reports the percentages of people with Medicare living in the community — broken out by sex — who report certain physical and mental conditions, living conditions, and conditions that impact access to care and health outcomes (e.g., affordability, transportation).

*CMS Issues Request for Application for Rural Community Hospital Demonstration*

December 20: CMS announced a Request for Applications [ https://www.federalregister.gov/public-inspection/2024-30719/medicare-program-rural-community-hospital-demonstration-program-solicitation-of-additional ] (RFA) for the Rural Community Hospital Demonstration [ https://www.cms.gov/priorities/innovation/innovation-models/rural-community-hospital ]. The congressionally mandated demonstration tests the feasibility and advisability of cost-based reimbursement for small rural hospitals with fewer than 51 beds that are not eligible to be Critical Access Hospitals (CAHs). Interested hospitals must apply by 11:59 p.m. EST on March 1, 2025.

*CMS Publishes Explanations for Negotiated Drug Prices*

December 20: CMS published explanations [ https://www.cms.gov/inflation-reduction-act-and-medicare/medicare-drug-price-negotiation ] for the agreed-upon drug prices for the first cycle of the Medicare Drug Price Negotiation Program, which will become effective in 2026. The explanations provide information about CMS’ perspective on the data that had the greatest impact on CMS’ determination of offers and consideration of counteroffers consistent with the factors outlined in the law. CMS also released redacted information regarding the data received, the exchange of offers and counteroffers, and the negotiation meetings, if applicable.

*CMS Releases List of Hospices Selected to Participate in the Hospice Special Focus Program*

December 20: CMS released the list of the initial cohort of 50 hospices selected for participation in the Hospice Special Focus Program [ https://www.cms.gov/medicare/health-safety-standards/certification-compliance/hospice-special-focus-program ](SFP) in 2025. The SFP is required by statute and drives hospice quality improvement through increased health and safety oversight. This effort is a continuation of CMS’ commitment to improving hospice care for patients and families by holding hospice agencies accountable to national health and safety standards. CMS will continue to work with providers, patients and their families, and industry, to improve hospice care across the nation.

*CMS Issues Report on Use of Waivers & Flexibilities in Response to COVID-19 Public Health Emergency *

January 2: CMS published a report [ https://www.cms.gov/files/document/covid-19-phe-report-congress.pdf ]_ _highlighting the agency’s Fiscal Year 2023 COVID-19 Public Health Emergency response and use of Section 1135 waivers and other flexibilities. CMS uses emergency Section 1135 waivers to ensure program participants have access to services during a national emergency and that providers have the flexibility to provide and be paid for services. The report focuses on six key areas, including vaccines and therapeutics, testing, telehealth, emergency reporting, surge capacity, and long-term care facilities. The report summarizes CMS’ policy response and synthesizes external feedback gathered from a variety of sources. It also includes discussions and recommendations on several cross-cutting issues, such as workforce capacity, health care disparities, quality improvement and patient safety, and process improvements in the execution of Section 1135 waivers and flexibilities. A summary can be found on this fact sheet [ https://www.cms.gov/files/document/health-care-system-resiliency-fact-sheet.pdf ].

*CMS Names States Participating in the Transforming Maternal Health Model*

January 6: CMS announced the 15 states participating in the Transforming Maternal Health (TMaH) model [ https://www.cms.gov/priorities/innovation/innovation-models/transforming-maternal-health-tmah-model ]. The model supports participating state Medicaid agencies in the development of a whole-person approach to pregnancy, childbirth, and postpartum care that addresses the physical, mental health, and social needs experienced during pregnancy.

*CMS Updates Information on Hospital Price Transparency Compliance Requirements*

January 7: CMS posted updated FAQs [ https://www.cms.gov/files/document/hospital-price-transparency-frequently-asked-questions.pdf ] on hospital price transparency compliance requirements. Some of the FAQs are related to new requirements that will be effective January 1, 2025, as finalized in the Calendar Year 2024 Outpatient Prospective Payment System/Ambulatory Services Center Final Rule, and others are modifications to existing requirements as detailed in previous FAQs. The new and revised FAQs will help hospitals and other interested parties better understand how to meet the requirements and provide additional helpful information.

*CMS Announces Funding Opportunity to Recruit RNs to Work in Nursing Homes, State Survey Agencies*

January 8: CMS announced a _Notice of Funding Opportunity_ (NOFO) available through the _Nursing Home Staffing Campaign_. The NOFO will accept applications from organizations interested in administering financial incentives aimed at recruiting registered nurses (RNs) to work in nursing homes and state survey agencies. Organizations eligible to apply are non-profit organizations that have relationships with RN schools or RN students.

*Other Recent Releases: *

December 20: HHS Announces Cost Savings for 64 Prescription Drugs Thanks to the Medicare Prescription Drug Inflation 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-prescription-drug-inflation-rebate ] __

January 8: Nearly 24 Million Consumers Have Selected Affordable Health Coverage in ACA Marketplace, With Time Left to Enroll [ https://www.cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left ]

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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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