Fact Sheet for State and Local Governments – CMS Programs & Payment for Care in Hospital Alternate Care Sites

In response to the COVID-19 public health emergency, state and local governments, hospitals, and others are developing alternate care sites to expand capacity and provide needed care to patients. This newly published fact sheet provides state and local governments developing alternate care sites with information on how to seek payments through CMS programs – Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) – for acute inpatient and outpatient care furnished at the site.

Fact Sheet

Webinar: What Communities Need to Know About Reopening During COVID-19

Date: May 28, 2020

Time: 12:00 PM Central

Click to Register.

Faith congregations and communities are eager to reconvene after months of remotely gathering.  Yet, as states start to reopen, how can faith leaders best care for their diverse communities while still gathering in the safest manner possible?

We want to help answer some of these important questions!
That’s why we have invited top experts from the Centers for Disease Control and Prevention (CDC) to review the most up-to-date information available regarding what communities need to know about COVID-19, available safety and prevention protocols, and helpful guidance on reopening worship facilities.


President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors through the Part D Senior Savings Model

May 26, 2020

Today, under President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. Across the nation, participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap.

Currently, Part D sponsors may offer prescription drug plans that provide lower cost-sharing in the coverage gap; however, when they do, the Part D sponsor accrues costs that pharmaceutical manufacturers would normally pay. These costs are then passed on to beneficiaries in the form of higher premiums. The new insulin model directly addresses this disincentive by doing two things: 1) allowing manufacturers to continue paying their full coverage gap discount for their products, even when a plan offers lower cost-sharing; and 2) requiring participating Part D sponsors’ plans, in part through applying manufacturer rebates, to lowering cost-sharing to no more than $35 for a month’s supply for a broad set of insulins.

Under President Trump’s leadership, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap. Both manufacturers and Part D sponsors responded to this market-based solution in force and seniors that use insulin will reap the benefits.

Based on CMS’s estimates, beneficiaries who use insulin and join a plan participating in the model could see average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model. With a robust voluntary response from Part D sponsors, CMS anticipates beneficiaries will have Part D plan options in all 50 states, the District of Columbia, and Puerto Rico, through either a standalone prescription drug plan (PDP) or a Medicare Advantage plan with prescription drug coverage. Beneficiaries will be able to enroll during Medicare open enrollment, which is from October 15, 2020 through December 7, 2020, for Part D coverage that begins on January 1, 2021.

The Part D Senior Savings Model – which was announced on March 11, 2020 – is a voluntary model that tests the impact on insulin access and care by participating Part D enhanced alternative plans offering lower out-of-pocket costs, at a maximum $35 copay for a month’s supply, for a broad range of insulins. Part D sponsors that participate in the model will offer beneficiaries Part D prescription drug plans that provide supplemental benefits for a broad range of insulins, including both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins. Participating pharmaceutical manufacturers will continue to pay their current 70 percent discount in the coverage gap for their insulins that are included in the model, and based on the model’s waiver of current regulations, those manufacturer discount payments will be calculated before the application of supplemental benefits under the model – which will reduce the out-of-pocket cost of insulin for Medicare beneficiaries.

Part D sponsors that applied must submit their calendar year 2021 plan benefits to CMS by June 1, 2020 to designate their participation in the model. CMS anticipates releasing the premiums and costs for specific Medicare health and drug plans for the 2021 calendar year in September 2020, including final information on the model.

More information can be found on the Part D Senior Savings Model web page.


Centers for Medicare & Medicaid Services (CMS) has sent this Center for Medicare and Medicaid Innovation (CMMI) Update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.

Funding Opportunity: Health Center Program Look-Alikes: Apply Now for Coronavirus Testing Funding

HRSA is now accepting applications from designated look-alikes for the fiscal year (FY) 2020 Health Center Program Look-Alikes: Expanding Capacity for Coronavirus Testing (LAL ECT) notice of funding opportunity (NOFO) (HRSA-20-147). The purpose of this funding is to support LALs in expanding their COVID-19 testing capacity. Applications are due in Grants.gov by 11:59 p.m. ET on Tuesday, June 2. More information is available on our LAL ECT Frequently Asked Questions (FAQ) webpage.

Webinar Recording: 2020 Uniform Data System Reporting Changes

The presentation and recording from our recent webinar focused on calendar year 2020 Uniform Data System (UDS) reporting changes are now available on HRSA’s website. 2020 UDS data reporting will take place between January 1 and February 15, 2021.

Key reporting changes include:

  • Addition of HIV screening measure (CMS349v2);
  • Addition of prescription for Pre-Exposure Prophylaxis (PrEP) International Classification of Diseases (ICD) 10 codes and Current Procedural Terminology (CPT) codes; and
  • Revision of Appendix D to capture information on prescription drug monitoring programs (PDMPs) and social determinants of health.

For additional information, see Program Assistance Letter (PAL) 2020-04: UDS Changes for Calendar Year 2020.

2020 Health Center Patient-Centered Medical Home Recognition Quality Improvement Awards

Health centers that have Patient-Centered Medical Home (PCMH) recognition by Wednesday, July 1, 2020, may be eligible to receive the 2020 Health Center PCMH Recognition Quality Award. View the table of health centers with valid PCMH recognition status and the number of sites with PCMH recognition. If your health center serves multiple states, please be certain to check the number of sites for EACH state to calculate the total number of PCMH-recognized sites in HRSA’s Electronic Handbooks (EHBs).

  • If your health center’s PCMH recognition is accurate, no action is needed.
  • If it is inaccurate, please submit an update to your PCMH recognition information via the EHBs no later than Sunday, July 5. View instructions for submitting an update, including the acceptable forms of required documentation.

If you have questions, please contact us. To make sure you receive our reply email, add ‘BPHCAnswers@hrsa.gov‘ to your address book.

Related to this, HRSA is sponsoring PCMH trainings in each region. Get more information in Additional Resources.