CMS Unveils More User-Friendly Medicare Website

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.

CMS Releases Proposed Rule Implementing Provisions of the Consolidated Appropriations Act, 2021

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. 

CMS Issues Final Rules on Marketplace Standards and Medicare Advantage and Part D Plans

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.   

The Compliance Team Announces New Clinical Disease Management Program

Date: May 9, 2022

The Compliance Team Announces New Clinical Disease Management Program

This new program recognizes community pharmacies for expanding roles and delivering clinical-based services.

Spring House, Pennsylvania — The Compliance Team (TCT), a Centers for Medicare and Medicaid Services (CMS) approved accreditation organization, has launched a new pharmacy-based program that focuses on clinical disease management (CDM). Pharmacies that achieve CDM recognition are acknowledged by TCT for their roles in helping patients with diabetes, hypertension, and cardiovascular diseases, subsequently improving their overall health outcomes and quality of life. The CDM program focuses on pharmacies that have already moved from or are in the process of moving from a transaction-based practice to a clinical-based practice that promotes continuous pro-active patient-centered care in the community.

The CDM Recognition Program verifies and validates pharmacies that meet the established quality standards for clinical disease management.

“This program is another indication of our commitment to serving the needs of community pharmacies,” explained The Compliance Team CEO Sandra Canally. “This certification is a focused validation of a pharmacy’s ability to move to a Value-Based Care model, where the focus is on clinical-based instead of transaction-based services.”

Traditionally, patients with diabetes, hypertension and high cholesterol seek care from their primary care providers; however, TCT knows that most patients see their pharmacists much more frequently. Pharmacy CDM recognition enables patients to receive their prescription medications from their community retail pharmacies, while benefiting from a higher level of pharmacy care. Most importantly, the pharmacy actively supports patients and their primary care providers in managing patients’ chronic conditions.

To participate in the new program, the pharmacy must develop a CDM program that is based on clinical evidence, guidelines, and best practices, and meets the related TCT quality standards. Under the program, the pharmacy will define target patients, establish measurable outcome goals, and develop individualized action plans to help patients achieve specific objectives. The pharmacy will need to identify tools and resources to enable pharmacists to continuously monitor patient health status, medication adherence, blood glucose and AIC levels for patients with diabetes, blood pressure for patients with hypertension, and blood cholesterol level for patients on statin medications. The CDM program incorporates patient self-management through diet and life-style modifications.

“Pharmacies that develop and implement a comprehensive CDM program can reduce overall health care costs and earn additional payment for their services by health plans and payers,” shared Canally. “It is yet another innovative solution developed by our amazing team to support our pharmacy providers.”

For more information on The Compliance Team’s clinic programs, go to www.TheComplianceTeam.org or call 215-999-6252.

Improving pharmacies and patients’ lives.

Improving Access to Virtual Care for Homebound Rural Veterans

Date: May 11, 2022

Improving Access to Virtual Care for Homebound Rural Veterans

Department of Veterans Affairs (VA) Geriatric Scholar Christy Rothermel from Coatesville VA is narrowing the rural digital divide by helping homebound Veterans stay apace with VA’s rapid telehealth expansion.

Rothermel has been a VA psychologist since 2009. She is part of a multidisciplinary Home Based Primary Care team (HBPC). The HBPC delivers in-home care to Veterans who are unable to travel to VA health care facilities because of complex medical conditions or mobility restrictions. She arrived at Coatesville VA in Pennsylvania just before the start of the COVID-19 pandemic.

“When the COVID pandemic began, in-home visits were significantly restricted for the safety of our Veterans, their family members and VA staff. It became even more important to keep our Veterans connected to their health care team and to VA support and resources. I felt that virtual care could really fill a gap that was created by COVID in terms of face-to-face care,” said Rothermel.

Virtual care appointments spiked during COVID-19 restrictions compared to pre-pandemic levels. But they began to drop with the reopening of in-home visits.

Sustaining momentum of increased use of VA Video Connect

After attending the VA Geriatric Scholars Program, a national workforce development program, she and her team decided to build on the momentum achieved during the pandemic. They did this with a quality improvement project to improve access to VA Video Connect, VA’s secure video conferencing app.

VA Geriatric Scholar Dr. Christy Rothermel

VA Geriatric Scholar Dr. Christy Rothermel

“One of the first things we did was identify all the barriers we could possibly think of that were limiting our patient’s access to being VA Video Connect capable,” said Rothermel.

They began by focusing on newly enrolled HBPC patients, opening the conversation about VA Video Connect during the admission process. “We were able to get their input in terms of what might be holding them back. Did they not have a smart device or were they concerned about not knowing the technology? Those sorts of things,” said Rothermel.

“The largest barrier was that there were Veterans who had a functional, neurological or medical impairment that made them unable to use the device,” explained Rothermel. “An example might be Parkinson’s disease, where the individual might have tremors or involuntary muscle movements. Or they might have a cognitive disorder where the individual may be unable to learn new information, such as the steps to sign into a virtual appointment on an iPad.”

Yet many of these patients had caregivers who wanted the tools and digital skills to help facilitate Veterans’ virtual visits. “We would work with the caregiver and provide that to them,” said Rothermel. “We want to assist the caregiver as much as we can. They really help a lot with virtual appointments.”

VA teams coordinate patient care to address barriers

In addition to supplying iPads, the team proactively addressed Veterans’ unique needs and circumstances prior to conducting a virtual visit.

For Veterans with hearing impairments, they provided pocket talkers. They also placed a consult with audiology to involve their expertise. Pocket talkers are listening devices that improve the ability to hear. “We found that they work very well with iPads and Veterans were able to hear me,” said Rothermel.

For patients with vision loss, they coordinated care with VA’s Visual Impairment Services Team. This team provided patients with the adaptive technology needed to conduct a virtual appointment.

People receptive and found it really helpful

They also enlisted the assistance of VA technical support specialists to walk Veterans through the set-up and use of their devices. “Once the education is provided, they see it’s not as difficult as they may have imagined,” said Rothermel. “There’s been a lot of positivity. People have been receptive and found it really helpful because you can easily get in touch with your provider and see them virtually.

“COVID was rough for our homebound Veterans. One Veteran said that VA Video Connect was his lifeline during COVID. Having the virtual care connection with providers and other staff members is really important.”

Rothermel’s HBPC team now includes VA Video Connect capability as an essential part of treatment planning for all Veterans in their care.

Missouri health officials and pediatricians ask parents to use caution as nationwide infant formula shortages continue

Date: May, 10, 2022

Missouri health officials and pediatricians ask parents to use caution as nationwide infant formula shortages continue

As the nationwide infant formula shortage continues to affect parents and caregivers, state health officials and pediatricians urge Missourians to know the dos and don’ts of infant formula use and refrain from hoarding supply. The formula shortage, which began as a result of the COVID-19 pandemic supply chain challenges, continues today and is exacerbated by the recalls that occurred in February 2022.

“The combined shortage and product recall have created anxiety among infant parents and caregivers,” said Paula Nickelson, Acting Director, Missouri Department of Health and Senior Services (DHSS). “What often happens in these situations is that parents find alternative methods for feeding, and for infants, this could be dangerous and should be done in consultation with the child’s health care provider. We understand that manufacturers are doing everything they can to increase availability of formulas, and they are working closely with the FDA to ensure these products return to shelves to meet the current demand.”

Missourians are urged to follow these tips and consult their pediatrician with questions or concerns specific to their baby’s formula needs.

“Many different brands of infant formulas are FDA-regulated and are safe to use for most babies. Call your pediatrician or primary care provider if you have any questions,” said Dr. Maya Moody, President-Elect, Missouri Chapter, American Academy of Pediatrics. “Always mix the formula as instructed on the can or bottle, and never add extra water to dilute the formula.” 

Missouri WIC (Women, Infants, and Children) is administered by DHSS, and the program’s participants are some of those who have been greatly impacted by the formula shortage and recalls. Missouri WIC offers the following list of do’s and don’ts for all parents and caregivers.

DO:

  • Do feed your baby over 6 months old more baby food and less formula. A great resource, Food to Grow On: Birth to 12 months, provides a guide to the nutritional intake needed by babies during their first year of life.
  • Do wean your babies over 12 months old off formula. After their first birthday, babies no longer need formula to meet their nutritional needs. Caregivers can wean the baby using water, milk and food.
  • Do consider relactation. It is possible, with some effort, for women to relactate even if they did not breastfeed when their baby was born or were not able to for long. Contact a local IBCLC to help if you want to try to relactate.
  • Do search for formula at multiple stores in your area. Check the customer service desk at the store to see if they are keeping any there. Call a store before making the trip to check their supply or ask when the next supply truck arrives.
  • Do tell friends and family the brand and type of formula you use and ask them to pick it up for you if they see it in a store while shopping.
  • Do call your pediatrician if you run low and ask for guidance. They will be able to give you guidance on a safe formula switch or may even have samples to help you for a few days.

DON’T:

  • Don’t hoard formula. Only keep a monthly supply, at the most, to give other caregivers the opportunity to find formula. Hoarding is making the shortage worse!
  • Don’t make homemade formula. Without proper regulation, homemade infant formula may lack proper ingredients that are vital to infant growth and can cause life-threatening foodborne illnesses when consumed. There are many social media conversations about how homemade formula was used a long time ago and babies were just fine. They weren’t just fine. Babies died before commercial formula was widely available. The infant mortality rates were higher and babies were malnourished. Don’t make homemade formula.
  • Don’t dilute (water down) your baby’s formula to make it last longer. Your baby needs the full formula for proper nutrition and growth.
  • Don’t follow online advice except from trusted, expert sources. Your baby’s health and nutrition is too important to risk!
  • Don’t give cow’s milk or other milk substitutes to a baby under 1 year of age. Before your child is 12 months old, cow’s or goat’s milk may put him or her at risk for intestinal bleeding. It also has too many proteins and minerals for your baby’s kidneys to handle and does not have the right amount of nutrients for your baby.

The FDA shares additional infant formula safety tips here

###

About the Missouri Department of Health and Senior Services: The department seeks to be the leader in protecting health and keeping people safe. More information about DHSS can be found at health.mo.gov or find us on Facebook and Twitter @HealthyLivingMo.

Affordable Connectivity Program

Date: May 10, 2022

Affordable Connectivity Program Lowers Cost of Broadband Services for Eligible Households

The Centers for Medicare & Medicaid Services (CMS) is working to help build awareness about the Affordable Connectivity Program, a Federal Communications Commission (FCC) program.  The new long-term benefit will help to lower the cost of broadband service for eligible households struggling to afford internet service.

The Affordable Connectivity Program provides:

  • Up to $30/month discount for broadband service;
  • Up to $75/month discount for households on qualifying Tribal lands; and
  • A one-time discount of up to $100 for a laptop, desktop computer, or tablet purchased through a participating provider if the household contributes more than $10 but less than $50 toward the purchase price.

The Affordable Connectivity Program is limited to one monthly service discount and one device discount per household.

Who is Eligible?

A household is eligible for the Affordable Connectivity Program if the household income is at or below 200% of the Federal Poverty Guidelines, or if a member of the household meets at least one of the criteria outlined at https://www.fcc.gov/acp.

Two-Steps to Enroll

  1. Go to ACPBenefit.org to submit an application or print out a mail-in application; and
  2. Contact your preferred participating provider to select a plan and have the discount applied to your bill.

Some providers may have an alternative application that they will ask you to complete.

Eligible households must both apply for the program and contact a participating provider to select a service plan. 

For more information and full details, visit https://www.fcc.gov/acp or call 877-384-2575.

Check out the Consumer Outreach Toolkit at https://www.affordableconnectivity.gov/community-resources/

Read more about the ACP in the recent White House Fact Sheet: https://www.whitehouse.gov/briefing-room/statements-releases/2022/05/09/fact-sheet-president-biden-and-vice-president-harris-reduce-high-speed-internet-costs-for-millions-of-americans/