Harris-Walz Campaign Releases Proposal to add Home Care to Medicare
On October 8, Vice President Kamala Harris appeared on ABC’s “The View” and announced a proposal to add home care to the Medicare program. The proposal is to add at home services provided by home health aides, personal care attendants, or other qualified direct care workers with activities of daily living based on a clinical assessment of need. Under the proposal, these services would be offered at 20 hours or fewer a week and there would be cost sharing with a sliding scale. The proposal also includes language around “lifting up care workers” – but there are not a lot of details about what this would entail. The proposal builds on recent research from the Brookings Institution and from Georgetown University. The campaign proposes to pay for this new benefit by allowing Medicare to negotiate drug prices for all drugs, not just the limited number authorized by the Inflation Reduction Act. LeadingAge released a statement on the proposal that can be found here. We will continue to monitor this proposal closely.
CMS Provides Flexibilities to States Impacted by Hurricane Helene
The Centers for Medicare and Medicaid Services (CMS) has announced that they will make available Accelerated and Advance Payments and other flexibilities for providers and suppliers in states impacted by Hurricane Helene. Accelerated and Advance Payments may be granted in amounts equal to a percentage of the preceding 90 days of claims payments. Additional flexibilities include state waivers of 3-day stay requirements and benefit periods. These flexibilities are available to providers and suppliers within the Federal Emergency Management Agency (FEMA) disaster zones. Learn more here.
IV Solution Supply Disruption Likely to Impact Providers
Storm damage from September’s Hurricane Helene is contributing to supply disruption of healthcare products including intravenous (IV) solution. Healthcare providers, including post-acute and long-term care providers like nursing homes, home health, and hospice, are advised to implement conservation strategies. LeadingAge is working with federal agencies to obtain up to date information and resources to support providers. Check out this resource from the American Society of Health-System Pharmacists.
New Nursing Home Transparency Reporting Underway
As noted previously, the Centers for Medicare & Medicaid Services (CMS) has updated the Medicare Enrollment Application Form 855A for compliance with nursing home transparency reporting requirements finalized in November 2023. To implement these new requirements, under which nursing homes will now report ownership, management, and related party data to CMS, CMS has announced that the Medicare Administrative Contractors will be completing off-cycle revalidation of all nursing homes from October through December 2024. The updated form and accompanying guidance has been released; however, LeadingAge has several remaining questions and concerns, many of which were raised in our comments on the proposed rule. LeadingAge has reached out to CMS for clarification on these issues. Keep an eye on this issue by following the LeadingAge serial post, where we will be sharing updates as they become available.
PACE, Medicare Advantage Organizations, and Prescription Drug Plans
Software Release – MARx. In a memo released via the Health Plan Management System (HPMS) to PACE, Medicare Advantage (MA) plans, and Prescription Drug Plans on October 7, the Centers for Medicare and Medicaid Services (CMS) announced detailed software releases and system changes that plans should expect before the end of the year. In two separate releases, October and December, plans will now see inclusion of manufacturer discount program changes and the Medicare Prescription Payment Plan (MPPP) batch uploads will now require disenrollment reason codes. Additional details and program interface screen shots are available in the memo, here.
Implementation of Multiple Updates to the 2025 RxHCC Risk Adjustment Models, Monthly Membership Report, and Model Output Report. On October 8, the Centers for Medicare and Medicaid (CMS) released an informational memo via the Health Plan Management System (HPMS) detailing changes coming to multiple PACE-related models and reports. Changes to existing systems and reports are highlighted in yellow within the memo, and explicit changes are delineated by PACE and Non-PACE plans. Organizations interested in seeking clarification from CMS on questions relating to the contents of the memo can find specific resource account addresses for each updated report or model. The full memo is available here.
LeadingAge Comments on CMS Prior Authorization Data Collection
LeadingAge offered its support and input to CMS on its proposed data collection regarding Medicare Advantage plan initial service determinations and appeals (CMS-10905) in a comment letter submitted October 8. CMS outlined its goals for this data collection effort such as provide key information on “the utilization of benefits, enhance audit activities to ensure plans are operating in accordance with CMS guidelines, and ensure appropriate access to covered services and benefits.” LeadingAge has been pushing for CMS to have MA plans report prior authorization data for these exact purposes. Under the proposed data collection, MA plans would be expected to report quarterly to CMS on a series of data elements related to initial service determinations and appeals. LeadingAge encouraged CMS to expand the required data to include not only initial prior authorizations or other service determinations but also data on concurrent reviews and re-authorizations in order to provide a full picture of an MA enrollee’s health care journey and where the barriers to access exist. LeadingAge offered additional suggestions on data elements that required further clarification or that would enhance efforts to achieve CMS’s goals for the data. LeadingAge also recommended CMS disseminate the data through an annual report and consider publishing some of the data in Medicare plan finder as well as incorporating key metrics in the MA Star Rating program in the future. The proposal does not specify which year plans will be required to start submitting these data though we do know it would begin on January 1. To review the complete LeadingAge comment letter, click here.
Bill Would Set Cybersecurity Standards for American Health Care System
On September 26, Senate Finance Committee Chair Ron Wyden (D-OR) and Senator Mark Warner (D-VA) announced the introduction of legislation to improve cybersecurity in the U.S. health care system. Among other provisions, the “Health Infrastructure Security and Accountability Act” directs the Department of Health and Human Services to issue updated security standards for HIPAA-covered entities and business associates through rulemaking and establishes new statutory requirements for risk management and auditing. This LeadingAge article summarizes the bill’s key provisions. LeadingAge is currently assessing the bill’s impact on aging services providers and the people they serve.
Survey on Challenges with Veterans Affairs.
We need your help. We have heard in multiple forums and networks that contracting, payment, and service authorization processes within the Department of Veterans Affairs (VA) programs are difficult, specifically for adult day services providers. Recently, we have heard of service plan reductions because of policy changes along with years long struggles to become a contracted provider with the VA’s third-party administrators. The VA is interested in better understanding these issues and has requested more information on: individual problems, which VA Medical Center, which provider, and other issues in an effort to improve access to adult day services for veterans. LeadingAge is collecting this information to share with the VA and need to hear it from you. If you do NOT wish to have your information shared with the VA to facilitate a contact from them, please consider sending Georgia (ggoodman@leadingage.org) an email with your information, or omitting your email address from the completed form. The information is valuable even without us forwarding your contact information to the VA as we are working with congressional offices on this issue as well. A brief, perhaps 5-10 minute, questionnaire will help us better illustrate the problems to the VA. Please take the survey here. Thank you.
CMS Posts Resources from Access Rule Training Series: Critical Incident Management
The Centers for Medicare and Medicaid Services (CMS) hosted a webinar for states to offer compliance guidance on the recently finalized Medicaid: Ensuring Access to Medicaid Services Rule. (You can read our article on the rule here.) This webinar focused on compliance for states with provisions related to Critical Incident Management systems for home and community-based services programs. These systems could have different names across states, and typically manage reports of abuse, neglect, exploitation, etc. The final rule requires states to implement new or update existing systems to handle collection, tracking, and trending of incidents along with policy development by states to address and mitigate future incidents. States must comply with various provisions by July 10, 2029. The CMS HCBS Access rule training site has additional resources for states including recordings, slides, and transcripts from all trainings in the series. The next webinar will be held on October 9 at 3 p.m. ET; register here. The webinar’s focus is the HCBS Quality Measure Set.
CMS Reminds Nursing Homes of Residents’ Right to Vote
In a memo released September 26, the Centers for Medicare & Medicaid Services (CMS) reminded nursing homes of requirements to ensure residents are able to exercise their right to vote. This right, falling under Section 483.10 Resident Rights of the Requirements of Participation, requires nursing homes to support residents in exercising their rights are citizens and residents of the United States. This includes voting, registering to vote, and having access to people and resources. Read the memo here and check out these resources curated by LeadingAge to help you support residents’ right to vote.
Weekly Recaps: October 9, 2024
- Affordable housing Weekly Recap. Here is your weekly Affordable Housing Weekly Recap.
- Home Health Weekly Recap. Here is your weekly Home Health Weekly Recap.
- Hospice Weekly Recap. Here is your weekly Hospice Weekly Recap.
- Life Plan Community Weekly Recap. Here is your weekly LPC Weekly Recap.
- Medicaid, HCBS, and PACE Weekly Recap. Here is your weekly Medicaid, HCBS, and PACE Weekly Recap.
- Nursing Home Weekly Recap. Here is your Nursing Home Weekly Recap.
- Workforce Weekly Recap. Here is your weekly Workforce Weekly Recap.
