The House passed 10 of their 12 fiscal year (FY) 2021 appropriations bills this past summer, and until this week, the Senate had not posted any of their bills. However, on Tuesday, November 10, the Senate Appropriations Committee released the text of each of their 12 FY 2021 appropriations bills to spur negotiations ahead of the December 11, 2020, federal funding cliff. In recent weeks, both House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Mitch McConnell (R-KY) have expressed willingness and intent to pass a full appropriations package ahead of the expiration of the current continuing resolution (CR).

CMS released the 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule. This is the finalization of a 2018 proposed rule implementing policy changes with the attempt to streamline managed care regulations. The rule will give state Medicaid agencies greater flexibility to tailor their managed care programs to fit their specific populations.

In week one of the 2021 Open Enrollment period, 818,365 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

Every week during Open Enrollment, the Centers for Medicare & Medicaid Services (CMS) will release enrollment snapshots for the HealthCare.gov platform, which is used by the Federally-facilitated Exchange and some State-based Exchanges. These snapshots provide point-in-time estimates of weekly plan selections, call center activity, and visits to HealthCare.gov or CuidadoDeSalud.gov.

The final number of plan selections associated with enrollment activity during a reporting period may change due to plan modifications or cancellations. In addition, the weekly snapshot only reports new plan selections and active plan renewals and does not report the number of consumers who have paid premiums to effectuate their enrollment.

As a reminder, New Jersey and Pennsylvania transitioned to their own SBE platforms for 2021, thus they are not on the HealthCare.gov platform for 2021 coverage. Those two states accounted for 578,251 plan selections last year, accounting for 7% percent of all plan selections.  These enrollees’ selections will not appear in our figures until we announce the State-based Marketplace plan selections.

Definitions and details on the data are included in the glossary.

Glossary

Plan Selections: The cumulative metric represents the total number of people who have submitted an application and selected a plan, net of any cancellations from a consumer or cancellations from an insurer that have occurred to date. The weekly metric represents the net change in the number of non-cancelled plan sections over the period covered by the report.

Plan selections will not include those consumers who are automatically re-enrolled into a plan.

To have their coverage effectuated, consumers generally need to pay their first month’s health plan premium. This release does not report the number of effectuated enrollments.

New Consumers: A consumer is considered to be a new consumer if they did not have 2020 Exchange coverage through December 31, 2020, and had a 2021 plan selection.

Renewing Consumers: A consumer is considered to be a renewing consumer if they have 2020 Exchange coverage through December 31, 2020, and either actively select the same plan or a new plan for 2021.

Exchange: Generally, this report refers to 36 states that use the HealthCare.gov platform for the 2021 benefit year. The states using the HealthCare.gov platform for the individual market Exchange are Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

HealthCare.gov States: The 36 states that use the HealthCare.gov platform for the 2021 benefit year, including the Federally-facilitated Exchange and some State-based Exchanges.

Consumers on Applications Submitted: This includes a consumer who is on a completed application submitted to the Exchange using the HealthCare.gov platform. If determined eligible for Exchange coverage, a consumer still needs to pick a health plan (i.e., plan selection) and pay their premium to get covered (i.e., effectuated enrollment). Because families can submit a single application, this figure tallies the total number of people on a submitted application (rather than the total number of submitted applications).

Enhanced direct enrollment (EDE): The pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a user-friendly enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center. Applications and plan selection made through the EDE channel are included in the overall metrics presented above.

Call Center Volume: The total number of calls received by the call center for the 36 states that use the HealthCare.gov platform for the 2021 benefit year over the time period covered by the snapshot. Calls with Spanish speaking representatives are not included.

Calls with Spanish Speaking Representative: The total number of calls received by the call center for the 36 states that use the HealthCare.gov platform for the 2021 benefit year over the time period covered by the snapshot where consumers chose to speak with a Spanish-speaking representative. These calls are not included within the Call Center Volume metric.

HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users viewed or interacted with HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once.

Window Shopping HealthCare.gov Users or CuidadoDeSalud.gov Users: These user metrics total how many unique users interacted with the window-shopping tool at HealthCare.gov or CuidadoDeSalud.gov, respectively, over the course of a specific date range. For cumulative totals, a separate report is run for the entire Open Enrollment period to minimize users being counted more than once during that longer range of time and to provide a more accurate estimate of unique users. Depending on an individual’s browser settings and browsing habits, a visitor may be counted as a unique user more than once. Users who window-shopped are also included in the total HealthCare.gov or CuidadoDeSalud.gov user total.

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is recognizing National Diabetes Month in November. According to the Centers for Disease Control and Prevention (CDC), an estimated 34 million people in the United States have diabetes, and 1 in 5 of them don’t know they have it. Diabetes occurs because of the body’s inability to produce insulin, the hormone that regulates blood sugar levels. If the body doesn’t make enough insulin, sugar can’t get into the cells and blood sugar levels can rise. High blood sugar can lead to health problems including heart disease, kidney disease, stroke, and blindness.

CMS has added a new “Insulin Savings” filter on Medicare Plan Finder to display plans that will offer the capped out-of-pocket costs for insulin. Beneficiaries use the Medicare Plan Finder to view plan options and look for a participating plan in their area that covers their insulin at no more than a $35 monthly copay.

Diabetes is an important issue to CMS OMH because racial and ethnic minorities are at a higher risk of developing diabetes. Many who are diagnosed experience challenges managing their diabetes and are more likely to experience complications. Several factors including lack of access to health care, quality of care received, and socioeconomic status are all barriers to preventing diabetes and having effective diabetes management once diagnosed.

Below are several additional resources that can help health care professionals, patients, and their families manage diabetes:

Consumer Resources

• Use the Medicare Plan Finder on Medicare.gov with more than 1,600 prescription drug plans to choose from that will offer insulin at no more than a $35 monthly copay beginning in January. Read more here: https://www.medicare.gov/blog/find-medicare-plans
• Download Managing Diabetes: Medicare Coverage and Resources, a new resource to help patients with managing their diabetes and health coverage. This resource is also available in Spanish.
• Watch Connecting the Dots, an animated video that provides chronic care management services information for Medicare patients living with multiple chronic conditions.

Partner Resources:

• Read CMS OMH’s Diabetes Management: Directory of Provider Resources, which identifies resources on the management of type 2 diabetes that could be useful for providers and care teams.
• Review our data snapshot, Diabetes Disparities in Medicare Fee-for-Service Beneficiaries that provides an overview of diabetes diagnoses data by race, ethnicity, and gender among Medicare beneficiaries.
• Review the data highlight Chronic Kidney Disease Often Undiagnosed in Medicare Beneficiaries.
• Read CMS OMH’s Racial and Ethnic Disparities in Diabetes Prevalence, Self-Management, and Health Outcomes among Medicare Beneficiaries, which examines the prevalence of diabetes among Medicare beneficiaries based on a variety of factors.
• View CMS OMH’s A Culturally and Linguistically Tailored Type 2 Diabetes Prevention Resources Inventory, which identifies resources for providers and care teams focusing on prevention and evidence-based lifestyle intervention.
• Download the Connected Care Toolkit, a chronic care management (CCM) resource that contains educational materials to raise awareness about the importance of CCM services for Medicare and dual-eligible patients with multiple conditions.
• Learn more about the new “Insulin Savings” filter on Medicare Plan Finder to display plans that will offer the capped out-of-pocket costs for insulin.

To learn more about CMS OMH and to download resources, please visit https://go.cms.gov/omh or contact us at OMH@cms.hhs.gov.

National Public Radio

As of Jan. 20, 2021 — Inauguration Day — the federal government is about to get much more involved in health care and the COVID-19 pandemic response. Exactly how much more involved, now that Joe Biden is president-elect, depends on whether Republicans keep control of the Senate. And that likely won’t be determined until early January, when Georgia’s two Senate run-off races are held.

Trump’s nearly four years as president have been marked by a scaled-back federal investment and involvement in health care in a range of ways — giving states more authority to run their own health insurance markets, for example, and leaving them to come up with their own strategies for COVID-19 testing, contact tracing and more.

Biden’s pledge during the campaign was to reverse that trend. He wants to double-down and invest in the changes the Affordable Care Act made to the country’s health care system, he says. He wants to pour trillions into a unified coronavirus strategy. And he wants to work with Congress to create a Medicare-like public insurance plan that anyone can buy into — what he’s called the “public option.”

Here’s a guide to his policy platforms and promises related to health care. Again, how much he’s able to deliver on will in some cases depend on what happens in the Senate.

Read more.

The Centers for Medicare & Medicaid Services (CMS) proposed policy changes for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule effective April 1, 2021, or the date immediately following the duration of the COVID-19 public health emergency.  Under the rule, CMS is proposing continuation of higher payment rates for items and services furnished in rural and non-contiguous areas, classifying all continuous glucose monitors as DME, and revisions to the application process for common procedure codes.

The Centers for Medicare & Medicaid Services (CMS) finalized Medicare payment policy updates for renal dialysis services provided to Medicare beneficiaries beginning January 1, 2021. The final rule includes an overall payment increase of 2.0 percent or $250 million for all ESRD facilities, while rural ESRD facilities are estimated to experience a 1.0 percent increase as a result of the proposed changes. Other policy changes include adoption of the 2018 OMB delineations, expansion of the list of new equipment and supplies, TPNIES, to include home dialysis machines, and updates to the low-volume payment adjustment due to the COVID-19 public health emergency.

Under the Medicare Quality Payment Program (QPP), clinicians can participate in two tracks for payment purposes based on their practice size, specialty, location, or patient population: the Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model (APM).  The criteria for clinicians to qualify as a participant in an APM are changing as of January 1, 2021, so the Centers for Medicare & Medicaid Services (CMS) developed a Quick Start Guide and an Eligibility Decision Tree to help clinicians determine if they qualify for an APM or if they will need to participate in MIPS in 2021. Find more information here.