Date: May 18, 2022

CMS NEWS: CMS Unveils More User-Friendly Medicare Website

New Medicare.gov will incorporate public feedback and make it easier to compare, choose, and understand Medicare coverage.

On May 18, 2022, the Centers for Medicare & Medicaid Services (CMS) unveiled several updates to the Medicare.gov website that make it easier, for millions of people who use it, to navigate and access information to compare and select health and drug coverage and find providers. The updated website, based on consumer feedback, prominently features timely initiatives and messages on the homepage and highlights key tasks and information most frequently sought by people with Medicare, people nearing Medicare eligibility, and their families.

“CMS is making Medicare.gov easier to use and more helpful for people seeking to understand their Medicare coverage, which is an essential part of staying hea­­lthy,” said CMS Administrator Chiquita Brooks-LaSure. “We are committed to listening to the people we serve as we design and deliver new, personalized online resources and expanded customer support options for people with Medicare coverage and those who support them.”

Since 2021, CMS has introduced a number of enhancements to Medicare.gov to create a more welcoming and user-friendly experience. This week’s improvements redesign the Medicare.gov home page and, also, add more detailed pricing information about Medicare Supplement Insurance (Medigap) Policies that give individuals the information they need to compare Medigap plan costs and coverage options. CMS is committed to providing comprehensive and easily accessible information to support people with Medicare in their decision making. Additional improvements are planned for the next few months to streamline the Medicare Plan Finder landing page and the Medicare Account landing page, and align the look and feel with the new home page.

Other updates to Medicare.gov throughout the past year include using simple language to answer complex questions people often have about Medicare coverage and step-by-step guidance to help people who are new to Medicare understand their coverage options and when they need to sign up. For example, a redesign of the “Get started with Medicare” section in the summer of 2021 guides users through a few questions to get personalized information for their unique situation to make it faster and easier to learn about Medicare and sign up. Updates to improve user-friendly navigation on the website include the implementation of a simple and modern consistent header in early 2021.

CMS continues to use feedback from Medicare.gov users, along with human-centered design principles, to explore and plan future enhancements to the website and is committed to expanding personalization to create an optimized customer experience for people with Medicare and those who help them.

Date: May 17, 2022

Grassroots Advocacy Forum: CMS Releases Proposed Rule Implementing Provisions of the Consolidated Appropriations Act, 2021

On April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to implement sections of the Consolidated Appropriations Act of 2021 (CAA). These provisions would simplify Medicare enrollment rules and extend coverage of immunosuppressive drugs for certain beneficiaries. Key provisions include: 

Beneficiary Enrollment Simplification  

Effective January 1, 2023, when an individual enrolls in Medicare Part B during their last three months of eligibility, enrollment will become effective the month after. Currently, when an individual enrolls during the last three months of eligibility, coverage becomes effective in two to three months. This new provision will reduce gaps in coverage. 

Special enrollment periods (SEPs) are proposed for individuals who meet exceptional conditions and missed an enrollment period. Under this change, individuals who missed an opportunity to enroll would not have to wait until the general enrollment period (GEP). CMS proposes SEPs for the following situations: 

• Individuals impacted by an emergency or disaster, as declared by a local, state, or federal entity. This includes individuals who remained covered by Medicaid during the COVID-19 Public Health Emergency (PHE) even though they became eligible for Medicare during that period but did not take actions to enroll. Individuals who will lose Medicaid coverage on January 1, 2023, or the end of the PHE, whichever is earlier, and missed a Medicare enrollment period will have a SEP. 
• Health plan or employer error for individuals that can prove their employer or health plan materially misrepresented information related to timely Medicare enrollment. 
• Formerly incarcerated individuals following their release. 
• Enrollment in Medicare following termination of Medicaid coverage. 
• Other exceptional conditions that would be determined on a case-by-case basis when an individual missed enrollment due to circumstances beyond their control.  

State Payments for Medicare Premiums 

CMS proposes to streamline state buy-in policies by mandating that provisions of a state buy-in agreement must be set forth in the state’s Medicaid plan.  

Currently, all states are in agreements with the Secretary to facilitate payments of Part B premiums for Medicare-eligible Medicaid beneficiaries, called buy-in agreements. However, these agreements have not been amended since 1992. Rather, states have used their Medicaid state plans and state plan amendments to document state buy-in election choices and amendments. To make the buy-in process more efficient, CMS proposes to require that all buy-in provisions and agreements with the Secretary be set forth in states’ Medicaid plans. This would eliminate the free-standing buy-in agreements between states at the Secretary and instead, all changes would be effectuated through the state Medicaid plans. 

Additionally, CMS is proposing to simplify situations in which the Social Security Administration establishes retroactive Medicare Part A entitlement for Medicaid beneficiaries as part of disability determinations. This action can make states liable for retroactive Part B premiums going back several years. CMS proposes to limit retroactive Medicare Part B premium liability for states to 36 months for full-benefit dually eligible beneficiaries. 

Extended Months of Coverage for Immunosuppressive Drugs 

This proposal would apply to individuals with end stage renal disease (ESRD). Individuals with ESRD are generally eligible for Medicare regardless of age. The CAA mandated that an individual who does not have other health insurance coverage would be eligible to enroll in Part B beyond the 36-month post-kidney transplant period for the limited purpose of getting Part B coverage for immunosuppressive drugs. Individuals would only receive coverage for immunosuppressive drugs, not any other Part A or B benefits. 

This benefit would have no enrollment period. Eligible individuals could enroll at any time. Individuals would be able to enroll in the new immunosuppressive drug benefit beginning in October with coverage beginning January 1, 2023. 

CMS’s fact sheet can be found here. The unpublished proposed rule can be found here. Comments on the proposed rule are due sixty days after publication in the Federal Register.  

For further questions, please contact Alexa McKinley, NRHA’s Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team. 

Date: May 17, 2022

Grassroots Advocacy Forum: CMS Issues Final Rules on Marketplace Standards and Medicare Advantage and Part D Plans

The Centers for Medicare and Medicaid Services (CMS) recently released two final rules – one finalizing new Marketplace standards and another revising Medicare Advantage (MA) and Part D regulations. Please see below for key provisions of the rules. 

CY 2023 Medicare Advantage and Part D Final Rule 

Key changes to CMS final rural implementing changes to Medicare Advantage (MA) and Part D regulation include revising regulations on marketing and communications, new criteria used to review applications for new or expanded MA and Part D plans, special requirements during disasters or public emergencies, and changes to how MA organizations calculate attainment of maximum out-of-pocket limits. All changes will apply to coverage beginning January 1, 2023, which is a one-year delay in implementation. The regulations will be effective June 13, 2022, meaning that MA plan bids submitted for CY 2023 will be evaluated using the regulations below. 

Rural enrollment of Medicare beneficiaries in the Medicare Part D prescription drug program has historically lagged urban enrollment. Rural Part D enrollees are overwhelmingly in standalone prescription drug plans (PDPs), whereas urban beneficiaries are more likely to be enrolled in Medicare Advantage with Prescription Drug (MA-PD) plans. However, enrollment in MA plans has grown tremendously with MA plans as an alternative to traditional Medicare becoming increasingly popular among rural beneficiaries according to the RUPRI Center for Rural Health Policy Analysis. As Part D enrollment grows in rural areas, these proposed changes become more relevant for rural Medicare beneficiaries. 

Direct and Indirect Remuneration (DIR) Fees. Starting next year, Medicare Part D prescription drug plans and MA plans must include direct and indirect remuneration (DIR) fees at the point of sale, not retroactively. NRHA anticipates this change to help with rural hospital and pharmacy contract relationships. The new requirement will take effect in 2024.  

Beneficiary Cost Sharing at Pharmacies. The rule also modifies the definition of “lowest price,” which influences the lowest reimbursement a pharmacy can receive from a Part D drug plan. CMS is finalizing a policy that requires Part D plans to apply all price concessions they receive from network pharmacies to the negotiated price at the point of sale, so that the beneficiary can also share in the savings. CMS is redefining the negotiated price as the baseline, or lowest possible, payment to a pharmacy, effective January 1, 2024. This will reduce beneficiary out-of-pocket costs. 

Maximum Out-of-Pocket (MOOP) Costs. Currently, MA plans have the option to count only the amounts that the enrollee is responsible for paying, but not count state cost-sharing or unpaid cost-sharing towards the MOOP limit. This final rule specifies that the MOOP limit in an MA plan (after which the plan pays 100 percent of MA costs) is calculated based on the accrual of all Medicare cost-sharing in the plan benefit, whether that Medicare cost-sharing is paid by the beneficiary, Medicaid, or other secondary insurance, or remains unpaid.  

MA Plan Networks. CMS is improving application standards and oversight of MA applicants’ provider networks to ensure enrollees will have access to a sufficient network of providers before CMS will approve for the first time or allow an existing MA contract to expand. CMS will also protect Medicare beneficiaries by holding plans accountable to detect and prevent the use of confusing or potentially misleading marketing tactics by third-party marketing organizations. 

Emergencies and Disasters. CMS is revising and clarifying timeframes and standards associated with coverage obligations of MA plans during disasters and emergencies. The final rule will clarify that an MA plan must comply with the special requirements when there is both a declaration of disaster or emergency (including a public health emergency) and disruption in access to health care in the MA plan’s service area. 

Social Determinants of Health. CMS is finalizing requirements for all Special Needs Plans (SNPs) health risk assessments to include standardized questions regarding housing stability, food security, and access to transportation. All SNPs must include at least one question for each of these categories, but not all SNPs must use the same question.  

Appeals and Grievance Processes. This final rule simplifies the appeals and grievance processes and extends the protection of continuation of benefits pending appeal to additional dually eligible beneficiaries. 

MA Organization Past Performance. CMS will add Star Ratings (2.5 or lower), bankruptcy or bankruptcy filings, and exceeding a CMS designated threshold for compliance actions as bases for CMS denying a new application or a service area expansion application to a MA or Part D organization. 

Simplifying Dually Eligible Special Needs Program (D-SNP) Enrollee Materials. Many dually eligible beneficiaries have low health literacy yet must navigate a more complex system than non-dually eligible beneficiaries. This final rule codifies a mechanism through which states can require the D-SNPs in D-SNP-only contracts to use integrated materials to make it easier to understand the full scope of Medicare and Medicaid benefits available through the D-SNPs. 

Please find the final rule here. CMS’ fact sheet can be found here. These regulations are effective June 28, 2022. 

Marketplace Final Rule FY 2023 

Standardized Plan Options. Beginning in plan year (PY) 2023, CMS proposes to require that all issuers offer standardized plan options at every product network type, at every metal level, and throughout every service area that they offer non-standardized plan options. 

User Fees. CMS is finalizing a Federally-facilitated Marketplace (FFM) user fee rate of 2.75% of premium and a State-based Marketplaces on the Federal Platform (SBM-FP) fee of 2.25% of premium. 

Advancing Health Equity. CMS refines its essential health benefits (EHB) nondiscrimination policy to ensure that benefit designs, particularly benefit limitations and plan coverage requirements for EHB, are based on clinical evidence. CMS provides examples of presumptive discriminatory plan designs, such as discrimination based upon age and health conditions. 

Special Enrollment Period Verification. CMS finalizes changes to scale back pre-enrollment special enrollment period (SEP) verification in the FFMs and SBM-FPs to include only the SEP for loss of minimum essential coverage-the SEP type that comprises the majority of all SEP enrollments on the Marketplaces on the federal platform-and to clarify that Marketplaces maintain the option to verify eligibility for any SEP types and may provide an exception to pre-enrollment SEP verification when verification may cause undue burden, such as during natural disasters or public health emergencies impacting consumers or the Marketplace.   

Please find the final rule here. CMS’ fact sheet can be found here. These regulations are effective July 1, 2022. 

If you have any questions, please contact Alexa McKinley, NRHA’s Government Affairs and Policy Coordinator, at amckinley@ruralhealth.us or another member of the Government Affairs team.