Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make updates to the Medicare Advantage (MA) and Medicare Part D programs that would lower out-of-pocket prescription drug costs for beneficiaries with Medicare Part D and improve price transparency and market competition. The proposed rule would improve beneficiaries’ experiences with MA and Part D, with a strong emphasis on individuals who are dually eligible for Medicare and Medicaid. Ultimately, CMS is taking action to hold MA and Part D plans to a higher standard in offering benefits and improve health equity in the programs.

“We are dedicated to ensuring older Americans and those with disabilities who are served by the Medicare program have access to quality, affordable health care, including prescription drugs and therapies,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s proposed actions follow our guiding principles by improving health equity and enhancing access to prescription medications.”

In recent years, more Part D plans and pharmacies have entered into arrangements—called price concessions—where plans pay less money to pharmacies for dispensed drugs if the pharmacies do not meet certain metrics. However, there is no public visibility on these pharmacy price concessions, and these lower prices are not passed along to the beneficiary at the point of sale. In late 2018, CMS sought comment on a policy that would require Part D plans to apply all price concessions they receive from network pharmacies at the point of sale, which would reduce beneficiary cost-sharing. Having considered the comments, CMS is now proposing this policy, which would take effect January 1, 2023, to reduce beneficiaries’ Medicare Part D out-of-pocket costs and improve price transparency and market competition in the Part D program.

The proposed rule also takes steps to improve experiences for dually eligible beneficiaries who are enrolled in Dual Eligible Special Needs Plans (D-SNPs). D-SNPs are plans offered by MA organizations that enroll individuals who are eligible for both Medicare and Medicaid. The proposed rule would require that MA organizations with a D-SNP establish, maintain, and consult with one or more enrollee advisory committees to ensure the experiences of people with both Medicare and Medicaid are considered in plan decision making. The proposed rule would also simplify materials that describe how to access Medicare and Medicaid services and streamline the grievance and appeals processes in certain D-SNPs. The rule also proposes a change to MA cost-sharing rules that would result in more equitable payments to providers who serve dually eligible individuals and may improve dually eligible individuals’ access to providers.

In addition, CMS is proposing actions that reduce health disparities by ensuring that all MA special needs plans solicit information about an individual’s barriers to accessing care, through standardized questions in required health risk assessments on housing instability, food insecurity, and transportation. Also, the proposed rule seeks to protect people with Medicare by ensuring they receive accurate and accessible information about Medicare coverage. For example, CMS is proposing to strengthen oversight of third-party marketing organizations that act, directly or indirectly, on behalf of MA organizations and Part D sponsors. These changes include requiring that MA and Part D plans provide information in all required beneficiary communications about the availability of free translation services.

This proposed rule also protects beneficiaries by holding plans to a higher standard when reviewing applications for new or expanded MA plans by requiring that plan applicants demonstrate a sufficient network of contracted providers to care for beneficiaries. CMS also proposes to limit MA plans’ ability to expand or enter into new contracts if their previous performance is poor. This rule further protects beneficiaries by clarifying requirements for plans during disasters and emergencies to ensure that beneficiaries have uninterrupted access to needed services.

CMS is also proposing to hold plans more accountable for how Medicare revenue is spent, including providing greater transparency regarding the amounts used to provide supplemental benefits (e.g., dental, vision, hearing, transportation, meals) by requiring MA and Part D plans to expand reporting of information on the percent of plan revenue spent on patient care and quality improvement activities, known as the medical loss ratio.

In order to increase our understanding of issues related to access to behavioral health care for enrollees in MA plans, the agency also seeks feedback on the challenges with building behavioral health provider networks within MA health plans and the overall impact of potential CMS policy changes on network adequacy and behavioral health access in MA plans.

For a fact sheet detailing the CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P), please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-advantage-and-part-d-proposed-rule-cms-4192-p.

To view the proposed rule, please visit: https://www.federalregister.gov/public-inspection.

The Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid officials on the scope of and payments for qualifying community-based mobile crisis intervention services authorized by the American Rescue Plan Act of 2021.  The guidance describes the requirements for qualifying services and provider qualifications, options for provider payments, and the requirements for receiving an increased federal share of costs.  States are encouraged to take into account additional travel time when developing services for rural areas.  Research has found higher proportions of rural populations have mental illness and substance use disorder compared to urban as well as challenges accessing care.

I am Carole Johnson, and this week, I am joining HRSA as the Administrator.  I am especially delighted to join HRSA in this role, having spent time earlier in my career as part of the agency’s health care workforce team.  Returning to HRSA as Administrator is an honor, and I look forward to working each day with the incredibly committed staff, grantees and partners who make up the HRSA community.  I want to share my appreciation for Deputy Administrator Diana Espinosa’s dedication to the communities that HRSA serves and leadership as Acting Administrator over the past year.

Like you, I am deeply committed to HRSA’s mission of improving health outcomes and achieving health equity.  I have seen firsthand HRSA’s tireless efforts to provide equitable access to COVID-19 vaccination and services and to support health care providers struggling with the financial impacts of the pandemic through my work with the White House COVID-19 Response Team.  As Commissioner of the New Jersey Department of Human Services, which provides health care and social services to one-in-five New Jerseyans, I saw the impact of HRSA programs on ensuring access to affordable primary care, supporting health professionals who serve in underserved communities, and reducing disparities in infant and maternal health outcomes and HIV care.  I have also had the opportunity to work closely with HRSA and others inside and outside of government on implementing the Affordable Care Act and combating the opioid epidemic.

It’s an extraordinary list of services and supports that this team delivers in communities across the country, and it only happens with the help and partnership of so many community leaders.  I look forward to hearing your thoughts and feedback on how we can become an even stronger agency as we work to advance health equity and improve access to care and services for those who need it most.

With best wishes for the new year,

Carole Johnson

The Appalachian Regional Commission (ARC) is pleased to announce that Maryland Governor Larry Hogan has been selected to serve as their states’ co-chair for 2022.

Governor Hogan will be working collaboratively with all 13 Appalachian states and the ARC federal office to advance the strategic investment priorities in ARC’s 2022-2026 Strategic Plan.

During FY 2021, ARC invested more than $163 million in the Region, which is projected to leverage an additional $1.04 billion in private investments, create or retain nearly 21,000 jobs, and train over 25,000 students, workers, and leaders in new skills across Appalachia.

During January, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Poverty in America Awareness Month. There are 37.2 million Americans living in poverty, an increase of 3.3 million people since 2019. In 2020, racial and ethnic minorities continued to be disproportionately affected by poverty, with Black (19.5%) and Hispanic (17%) Americans shown to have poverty rates that were more than twice that of White Americans (8.2%).

There is a clear and established relationship between poverty, socioeconomic status, and health outcomes, with those living in poverty having an increased risk of chronic conditions, lower life expectancy, and barriers to receiving quality health care. The COVID-19 pandemic has also significantly impacted low-income families. In 2020, nearly half of lower-income families reported that they or someone in their household had lost a job or taken a pay cut as a result of the pandemic, impacting their abilities to meet basic economic needs and further disrupting access to health care. More specifically, these disparities in access to health care affected low-income families of color.

National Poverty in America Awareness Month offers an opportunity for CMS OMH to advance health equity for all Americans. CMS and other federal programs offer a variety of resources to help learn how to access health coverage, manage health care costs, and fully utilize benefits. Below is a list of resources that providers can share with their patients.

Resources

• Review the guide Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes, which provides step-by-step instructions for health care professionals on how to use Z codes which can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities. Find out more data on Z codes in this data highlight.
• View the Coverage to Care (C2C) Roadmap to Better Care and a Healthier You to help others better understand their health coverage and how to use it to access primary care and preventive services.
• Review the Manage Your Health Care Costs to help patients better understand health insurance costs and terms, know specific health insurance costs, plan for health care costs, and know how to pay premiums.
• Read the C2C Prevention Resources to learn more about preventive services that are available to adults, teens, children, and infants, with many available at no cost under most health coverage.
• Review eligibility requirements for Medicaid in your state as well as the Children’s Health Insurance Program (CHIP), a federal and state program that provides health coverage to children in families with incomes too high to qualify for Medicaid but too low for private coverage.
• Visit the Programs of All-Inclusive Care for the Elderly (PACE) webpage to learn how this program helps to meet the health care needs of the elderly in their own communities.
• View the Medicare Savings Program webpage to learn how members in your community can get extra help from their state.

Help your community learn more about how the Administration for Children and Families Low-Income Home Energy Assistance Program(LIHEAP) and Temporary Assistance for Needy Families (TANF) is helping to assist households meet important expenses like heating and food.

On December 31, 2021, the Federal Communications Commission (FCC) launched the Affordable Connectivity Program (ACP). This longer-term program was created by Congress in the Infrastructure and Jobs Act, and replaces the Emergency Broadband Benefit program.  This investment in broadband affordability will help ensure households can afford the internet connections they need for work, school, health care and more.

To support your ACP outreach efforts, the FCC also launched a toolkit of materials for partners to download and customize to meet their needs. More materials will be added in the coming weeks, so continue to check the page for new additions.

The ACP provides a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying Tribal lands. Eligible households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers if they contribute more than $10 and less than $50 toward the purchase price.

Enrollment in the ACP is now open for households with at least one member qualifying under any of the following criteria:

• Has an income that is at or below 200% of the federal poverty guidelines;
• Participates in certain assistance programs, such as SNAP, Medicaid, Federal Public Housing Assistance, SSI, WIC, or Lifeline;
• Participates in Tribal specific programs, such as Bureau of Indian Affairs General Assistance, Tribal TANF, or Food Distribution Program on Indian Reservations;
• Is approved to receive benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision;
• Received a Federal Pell Grant during the current award year; or
• Meets the eligibility criteria for a participating provider’s existing low-income program.

As the FCC transitions to this new program, the over 9 million households fully enrolled in the Emergency Broadband Benefit Program as of December 31, 2021 will continue to receive their current monthly benefit until March 1, 2022.

More information about steps current Emergency Broadband Benefit recipients must take to continue receiving the Affordable Connectivity Program benefit after March 1, 2022 will be available in the coming weeks.