Policy Round-Up: CMS proposed and final rules, SSI settlement, and more

In this policy round-up:

• Input Needed
  • CMS proposes steps to protect people with Medicare Advantage and prescription drug coverage; seeks comments on improving Medicare Plan Finder (Comments due 1/5)
  • Improving accessibility of transit facilities for people with disabilities (Comments due 1/5)
  • FTA and ODEP public dialogue on improving public transit
• CMS releases final rule to increase transparency of nursing home ownership
• New CMS resources: guidance on HCBS worker registries and data on ARP funding strengthening HCBS
• Justice in Aging resource on resident rights in assisted living
• Settlement provides relief for SSI recipients whose benefits were reduced or discontinued during the pandemic
• New CMS renewal resources available
• ICYMI: CMS finalizes rule establishing new Medicare codes to address health-related social needs

Input needed: CMS proposes steps to protect people with Medicare Advantage and prescription drug coverage; seeks comments on improving Medicare Plan Finder.

The Centers for Medicare & Medicaid Services (CMS) seeks input on a proposed rule to improve the Medicare Advantage (Part C) and the Medicare Prescription Drug Benefit Program (Part D).

Specifically, the proposed rule would:

• Establish guardrails for compensation to agents and brokers to prevent individuals from being steered into Medicare Advantage plans that don’t best meet their health care needs.
• Increase access to behavioral health care services for Medicare Advantage plan enrollees by proposing updates to network adequacy standards. The updates include adding a new “Outpatient Behavioral Health” facility-specialty, for which CMS sets Medicare Advantage plan network adequacy standards. The new facility-specialty includes:
  • Marriage and family therapists 
  • Mental health counselors
  • Opioid Treatment Program providers
  • Community Mental Health Centers
  • Addiction medicine physicians
  • Other providers who furnish addiction medicine and behavioral health counseling or therapy services as part of Medicare currently.
• Establish requirements designed to help ensure that benefits offered as special supplemental benefits for the chronically ill (SSBCI) are backed by evidence.
• Make changes to Dual Eligible Special Needs Plan (D-SNP) enrollment and offerings, including changes that would promote enrollment in integrated D–SNPs.
• Improve language access.

As part of this Notice of Proposed Rulemaking, CMS also is seeking comments on how to improve Medicare Plan Finder for people who are dually eligible for Medicare and Medicaid. 

Comments can be submitted online or by mail until 5pm ET on Friday, January 5. 

For more information on the proposed rule, check out this blog and this fact sheet from CMS.

Input needed: Improving accessibility of transit facilities for people with disabilities

The Department of Transportation (DOT) has published a Request for Information (RFI) on ways to improve the accessibility of public transportation facilities for people with disabilities. DOT is particularly interested in comments from transit riders, adaptive technology professionals, and the transit industry.

The RFI seeks input on:

• Standards for elevators and ramps,
• Communication processes and technology,
• Technology to help people find their way within transit stations, and
• Changes to current ADA standards

Comments can be submitted online or by mail until Friday, January 5.

Input needed: FTA and ODEP online dialogue on improving public transportation

The Department of Transportation’s Federal Transit Administration (FTA) and the Department of Labor’s Office of Disability Employment Policy (ODEP) invite the public to participate in an online dialogue on ways to improve public transit for everyone, including people with disabilities. Exploring the Future of Public Transportation Research will be an important virtual conversation on enhancing policies and practices to make public transit safer, cleaner, and greener as well as more resilient, inclusive and equitable.

The dialogue is open from now until January 5. Participants are encouraged to submit their own ideas, comment, and vote on ideas submitted by others.

The questions being posed include the ways research, technology, and innovation can be used to:

• Actively advance equity, particularly for people and communities that have historically been poorly served, including people with disabilities;
• Help the public transportation industry grow the economy and provide people without personal vehicles, especially people with disabilities, access to good paying jobs;
• Expand high quality public transportation service, improve mobility options, and connect communities to opportunities;
• Reduce adverse safety events, fatalities, and injuries involving public transportation; and
• Reduce greenhouse gas emissions from public transportation and create more resilient transportation systems

CMS releases final rule to increase transparency of nursing home ownership

CMS issued a final rule that will require the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities and Medicaid nursing facilities. 

The rule, which ACL has discussed previously, will also require nursing homes to disclose entities that exercise financial control over the facility, such as an organization the nursing home hires to manage all of its financial matters.

This new rule gives nursing home residents and their families the ability to make more informed decisions. Advocates have long argued that greater ownership transparency is necessary to know who is ultimately accountable for the care and services people receive in nursing homes.

For more on the rule, see this fact sheet from CMS.

New CMS resources: Guidance on HCBS worker registries and data on ARP funding strengthening HCBS

CMS recently released new guidance outlining how states can use worker registries for Medicaid-funded home and community-based services (HCBS) to ensure beneficiaries have awareness of, and access to, qualified workers to deliver these critical services. 

The guidance focuses on building and maintaining worker registries — worker management platforms that make qualified health workers easier to find — so more individuals receiving Medicaid-covered services can get care in a setting of their choice. The guidance also notes that significant federal funding is available through the American Rescue Plan (ARP) to help states build these registries.

CMS also released data on how enhanced funding for HCBS provided through the ARP has been invested to strengthen access to HCBS across the country. The funding includes investments in all states to help retain, expand, and train their direct care workforces, as well as investments to support family caregivers and reduce or eliminate waitlists for community-based care.

For more information, see this White House fact sheet.

Justice in Aging resource on resident rights in assisted living

Through state waiver programs, Medicaid HCBS programs are increasingly covering assisted living care. If a facility is certified to accept Medicaid HCBS payment, it must comply with federal residents’ rights and other legal protections. 

A new resource from Justice in Aging, Rights and Wrongs in Medicaid-Funded Assisted Living, provides residents and their representatives the advocacy tools to ensure facilities are following the law and treating residents appropriately. 

In addition, Justice in Aging recently hosted a related webinar, Resident Rights in Medicaid-Funded Assisted Living and Group Homes, discussing the federal protections available to residents and offering advocates tools for enforcing compliance with the law. A recording of that webinar is available here.

Settlement provides relief for SSI recipients whose benefits were reduced or discontinued during the pandemic

Last month, the Social Security Administration (SSA) reached a settlement to remedy issues that led to low-income older adults and people with disabilities who receive Supplemental Security Income (SSI) benefits being reduced or discontinued during the pandemic. As part of the settlement, SSA will:

• Waive all manually processed overpayments from March-September 2020, with some exceptions for fraud and other similar circumstances. SSI recipients will not need to take any action and all eligible recipients will receive a notice.
  • Any SSI recipients who were assessed overpayments during the COVID-19 National Emergency (March of 2020 to April of 2023) and are not receiving an automatic waiver will receive information on how to seek an overpayment waiver.
• Refund overpayments to SSI recipients, as applicable.
• Issue guidance reminding workers at SSA to consider COVID-19 related circumstances when making determinations about overpayments that happened during the COVID-19 National Emergency.

For more information, check out this fact sheet and press release from Justice in Aging.

New CMS renewal resources available

CMS recently released several new resources to help partners share with their communities information about Medicaid and CHIP renewals. These resources include a toolkit to help clinical offices and health care settings share informal about renewals with patients, drop in articles (available in English and Spanish) to help people keep their coverage and know what to do if they lose coverage, and informational postcards in additional languages. 

ICYMI: CMS finalizes rule establishing new Medicare codes to address health-related social needs

CMS published a final rule that establishes policy changes for Medicare payments under the Physician Fee Schedule, which go into effect January 1. These changes include new billing codes that ACL’s network will be able to use in partnership with Medicare Part B billing providers to get reimbursed for services such as person-centered planning, home and community-based services coordination, peer supports, building self-advocacy skills, and more. Medicare Part B pays for, among other things, doctor services, durable medical equipment, and home health services.

Specifically, the new billing codes pay separately for Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN) services when clinicians involve community health workers, care navigators, and peer support specialists to provide medically necessary care. The services described by the new billing codes are the first that are specifically designed to account for services involving support workers such as community health workers, care navigators, and peer support specialists.

CMS clarified in the rule that the community health workers, care navigators, peer support specialists, and other similar personnel may be employed by community-based organizations (CBOs) as long as there is the required supervision by the billing practitioner for these services, similar to other care management services. CBOs listed in the proposed rule include area agencies on aging, centers for independent living, aging and disability resource centers, community-action agencies, housing agencies and other non-profits that may receive grants from HHS agencies such as ACL or that contract with healthcare entities to perform social services.

The rule also clarifies that dental services may be covered when they are inextricably linked to covered services. These services include, for example, dental examinations and necessary treatment, prior to or during the treatment of head and neck cancers.

For more details on the rule, check out our blog.