The Centers for Medicare & Medicaid Services has announced that government payments to Medicare Advantage plans in 2025 are expected to increase an average of 3.7 percent from 2024. With the growing popularity of these private plans, it is important that policymakers and consumers understand how Medicare Advantage works, the key issues around cost and value, and ways to ensure plans provide effective, efficient, and equitable care. In Commonwealth Funds’ Medicare Advantage primer, learn more about:

• the differences between Medicare Advantage and traditional Medicare
• how the government pays plans
• why Medicare Advantage costs the government more than traditional Medicare
• and the extent of choices and competition among plans

As shared last week, a bipartisan group of six Senators released a discussion draft of a bill (the SUSTAIN 340B Act) that is perceived as a positive step in the 340B debate. This draft bill contains many positive policies from a Community Health Center perspective. These include:

• It explicitly allows for contract pharmacies and prohibits drug makers from placing conditions on them.
• It bans 340B discrimination (“pick-pocketing”) by including the text of the PROTECT 340B bill verbatim.
• While it requires reporting on the use of 340B savings, it does not require covered entities to explicitly quantify those savings and allows savings to be used for both “healthcare services” and “health-related benefits.”
• It creates a national data clearinghouse to streamline the process of submitting claims-level data to various payers and explicitly bans requirements that pharmacies put 340B modifiers on claims.

On the other hand, the bill: requires all contract pharmacies to offer a “sliding fee scale” on drug costs to self-pay patients with incomes up to at least 200% FPL; imposes user fees on all covered entities (the amount is to be determined, but the bill suggests 0.01 percent of a covered entity’s average 340B savings over the past 5 years); and requires covered entities to repay manufacturers for duplicate discounts on Medicaid drugs. This two-page overview of the 340b reform bill focuses on issues of interest to Community Health Centers. Initial reactions from a range of 340B stakeholders have been positive. The Senators also released a Request for Information on three key areas – contract pharmacies, patient definition, and hospital child sites (including whether there should be limits on the number or location of contract pharmacy locations) with comments due by April 1.

Democrat Jim Prokopiak emerged victorious in Tuesday’s special election for the 140th Legislative District seat. His victory means that Democrats will retain majority control of the chamber. Further complicating control of the House, Rep. Joseph Adams, R-Wayne, resigned from the state House last week. That means another special election to fill a vacancy in the state House. There were eight special elections for seats in the General Assembly in 2023 (seven of them involving House seat elections). The special election to fill Adams’ seat will coincide with the primary election on April 23.

An interactive map from the national nonprofit allows the user to search eligible summer 2024 locations for reduced priced meals at meal site or day care homes.  The map also shows qualifying rural areas that may provide non-congregate summer meals according to rural definitions used by the U.S. Department of Agriculture.

View the map here.

Accountable Care Organizations (ACOs) interested in participating in the Medicare Shared Savings Program (SSP) starting January 1, 2025 can follow this one-pager from the Centers for Medicare & Medicaid Services. SSP ACOs are groups of doctors, hospitals, and other health care providers who collaborate to give coordinated high-quality care to people with Medicare.  Phase 1 of the application process opens May 20^th and closes June 17^th.  Certain new ACO entities in rural and underserved areas may be eligible for Advance Investment Payments (AIPs), which are upfront and quarterly payments that can be used to build infrastructure and promote equity by addressing beneficiary needs.  AIPs are recouped from earned shared savings in current and subsequent agreement periods.

Read the full document here.

The Centers for Medicare & Medicaid Services updated the resource that provides a compilation of telehealth policies for state Medicaid agencies.  It includes flexibilities, requirements, and best practices for states to consider when using telehealth to deliver Medicaid and CHIP benefits and services, including in rural communities.  There is information about telehealth platforms; billing best practices; best practices during and after the COVID-19 Public Health Emergency; strategies to promote accessible and culturally competent care via telehealth; strategies for telehealth in value-based care; evaluation strategies to understand how telehealth affects quality, outcomes, and cost; and strategies for communicating, training, and providing resources on telehealth for providers and for beneficiaries.  Rural providers interested in learning more about telehealth policies, visit the National Consortium of Telehealth Resource Centers.

Read the full article here.

The Centers for Medicare & Medicaid Services (CMS) seeks public input on proposals intended to strengthen oversight of the nine-accrediting organization (AOs) that survey Medicare and Medicaid certified health care providers for compliance with health and safety requirements. CMS proposes to prohibit AOs from giving a hospital or other health care facility advance notice of a survey; penalize hospitals that receive a condition-level citation during a validation survey; and require AOs to use CMS’s Conditions of Participation as their minimum accreditation standards.

Read the full article here.

The Centers for Medicare & Medicaid Services (CMS) has updated guidance to now allow hospitals and Critical Access Hospitals to text patient information and orders to the electronic health records (EHR) using a HIPAA-compliant secure platform. Computerized Provider Order Entry (CPOE) continues to be the preferred method of order entry by a provider, but CMS recognizes there have been significant improvements in the encryption and interface capabilities of texting platforms to transfer data into EHRs since their last guidance was issued in 2018.

Read the full article here.

In the FY 2024 Inpatient Hospital Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized several changes to the information that eligible hospitals and Critical Access Hospitals report under the Medicare Promoting Interoperability Program.  CMS does not expect that these changes will increase the burden of collecting this information; however, they are required to give the public a second opportunity for public comment. Interested persons are invited to send comments regarding the estimated burden estimate or any other aspect of this collection of information, including the quality, utility, and clarity of the information to be collected.

Read the full article here.