It’s back to school with final rules

Renee Kinder

Time to fire up the printer, break out the highlighters and get back in the groove of learning.


Within a week’s time the Centers for Medicare & Medicaid Services issued final rules for:

Additionally, we received press releases related to CMS Acts to Improve the Safety and Quality of Care of the Nation’s Nursing Homes and CMS Seeks Public Feedback to Improve Medicare Advantage.

With all we have had to read in the last week from federal regulators, one can be left exhausted and feeling like back-to-school season has started with exams. Cliff’s Notes won’t cut it, either. While the links to the above fact sheets will give you a starting point, to fully comprehend the rules one must read, and in most cases re-read, the entire text to reach a level of understanding. 

For those of you who read my last blog related to UPAC you know that it is no longer a responsible choice in the world of skilled nursing to stay informed on regulatory change in your individual setting. 

The shifts we are seeing in the industry will likely soon bring us into a Montessori-esque world with the merging of settings and ages forcing us all to learn collectively from one another.

A bit of history helps us to understand why change is needed and was provided in yet another press release last week associated with the 57th Anniversary of Medicare and Medicaid.

Background:

Nearly 140 million Americans (74 million for Medicaid, nearly 64 million for Medicare) benefit today from Medicaid and Medicare.  

Medicaid:

  • Medicaid is the largest public health insurance program, covering more than 24% of the total U.S. population. Medicaid enrollment increased by 16.9 million, or 26.5%, from February 2020 (64.6 million) before the COVID-19 pandemic to March 2022 (80.9 million).
  • A total of 21 million newly eligible Medicaid beneficiaries as of April 2022 enrolled under the Affordable Care Act’s Medicaid expansion program.
  • Medicaid is the primary payer for nursing home care for people who need long-term care services across the nation, and the primary payer of home and community-based services (HCBS), which allow people with disabilities to live full lives in their community.
  • The program is also the single largest payer for mental health services in the United States and is increasingly playing a larger role in the reimbursement of substance use services.
  • More than 10 million Americans qualify for Medicaid based on a disability. People under age 65 who qualify for Medicaid on the basis of a disability include adults and children with disabilities present at birth as well as those who have disabling conditions acquired through illness, injury or trauma.

Medicare:

  • In 2021, Medicare covered 63.8 million people: 55.8 million aged 65 and older, and 8 million disabled.
  • In 2021, about 43% of these beneficiaries have chosen to enroll in Part C private health plans that contract with Medicare to provide Part A and Part B health services.
  • Seniors are more likely to have health insurance coverage than any other age group, due to the availability of Medicare coverage.
  • In 2021, 0.6% of people 65 and older were uninsured, compared with 4.4% among children (ages 0 to 17) and 14% among nonelderly adults (ages 18 to 64).
  • In 2021, Medicare Part D provides affordable prescription drug coverage to over 48.8 million Americans. The Affordable Care Act eliminated the Coverage Gap (“the donut hole”) in the original Part D benefit, reducing patient cost-sharing responsibility for drugs from 100% to 25%

What did CMS leadership have to say on this 57th anniversary that can provide us insight into the evolution we are seeing?

Navigation, access, quality and cost are the keywords that jump out to me from each statement below. 

Health and Human Services Secretary Xavier Becerra: 

“We are also working to make it easier for people to navigate their healthcare options under each program. For example, we have integrated behavioral health services into Medicare plans, extended postpartum coverage to a full year after pregnancy for Medicaid parents, and made care more accessible for the millions of seniors and people with disabilities by increasing funding for Medicaid home- and community-based services. Now, Congress has a critical opportunity to finally let Medicare negotiate a better deal on prescription drug prices for high-cost drugs — an action that could lower prescription drug costs for millions of seniors, individuals with disabilities, and other beneficiaries. 

“Medicare and Medicaid have helped connect Americans to care for generations, and we will continue to strengthen and expand these programs to ensure all Americans — no matter who they are or where they live — have access to high-quality, affordable healthcare.” 

CMS Administrator Chiquita Brooks-LaSure: 

“Over the last 57 years, Medicare and Medicaid have connected people to life-saving health coverage at critical moments in their lives. The Biden-Harris Administration is committed to building on that progress by expanding coverage, increasing access to care, and improving the quality of care that people receive. With enrollment at record levels, we’ve worked tirelessly over the past year to make enrollment transitions shorter and simpler, to improve the care that Medicare and Medicaid enrollees receive, and to expand the services and supports that our programs offer. And while there is much to celebrate, we continue to be laser-focused on ensuring that the promise of these programs remains protected, more robust, and stronger than ever for generations to come. Happy 57th Birthday, Medicare and Medicaid.” 

Back to the books for all of us during this back-to-school season. We all know well the importance and health benefits of being lifelong learners and, heck, if CMS can continue to mature in its 57th year, who are we all to complain about a little extra afternoon, nighttime, and weekend reading?

Onward to more review… once I find that darn highlighter. (Why can I never keep up with the highlighters?) 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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