In this policy round up:
- CMS finalizes Medicare Savings Plan rule addressing coverage affordability and access
- CMS releases 2024 Medicare premiums and deductibles
- Input Needed: Increasing support and equity in child welfare system
- $45 million in grants awarded to expand access to care for people with Long COVID
- Final rule requires national reporting of standardized Medicaid and CHIP quality measures to improve quality and advance health equity
- CMS letter to states on accurate automatic renewals for Medicaid and CHIP
- RSA awards nearly $199 million for demonstration projects to improve career opportunities for students with disabilities
- HHS launches Environmental Justice Community Innovator Challenge
- In Case You Missed It
- Proposed regulations for APS programs
- HHS proposes to strengthen protections against discrimination based on disability
- 988 Suicide & Crisis Lifeline adds American Sign Language services for Deaf and Hard of Hearing callers
CMS finalizes Medicare Savings Plan rule addressing coverage affordability and access
The Centers for Medicare & Medicaid Services (CMS) finalized a rule to streamline enrollment in the Medicare Savings Programs (MSPs), making coverage more affordable for an estimated 860,000 people. The rule will take effect on November 17.
MSPs currently cover Medicare premiums and, in most cases, cost-sharing for more than 10 million older adults and people with disabilities with limited incomes. However, only about half of those who are eligible are enrolled in MSPs, partly because of complicated application and verification processes now simplified by this rule.
For example, all Medicare-eligible individuals who receive Supplemental Security Income (SSI) are financially eligible for MSPs, but many are not enrolled because of how burdensome the application is. Under the new rule, many SSI recipients will now be enrolled automatically into the most comprehensive form of MSP coverage: the Qualified Medicare Beneficiary eligibility group, which covers Medicare premiums and cost sharing.
The rule also requires states to make better use of data from the Medicare Part D Low Income Subsidy (LIS) or “Extra Help” program, which helps many older adults and people with disabilities pay for prescription drugs and prescription drug coverage when they live on a limited income. Most of those people are eligible for, but not enrolled in, MSPs, and the changes finalized in the rule would promote more efficient enrollment of LIS beneficiaries in MSPs.
ACL administers programs that can help people eligible for Medicare apply for MSPs and LIS.
CMS releases 2024 Medicare premiums and deductibles
CMS recently released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. These rates are adjusted every year.
Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. Most Medicare beneficiaries do not have a Part A premium. However, some people have to pay a premium, including people 65 and older who haven’t worked in Medicare-covered employment long enough to be eligible for Part A otherwise and some individuals with disabilities who have exhausted other entitlements.
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period, after which, beneficiaries need to pay coinsurance.
Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. Medicare Part D covers prescription drug costs. Both Parts B and D have premiums, as well as income-related monthly adjustment amounts for beneficiaries with higher incomes, which affect roughly 8 percent of people with Medicare Parts B and D.
The newly announced rates go into effect January 1, 2024. CMS has published a fact sheet that reviews all the rate changes for 2024. In addition, more information on the rate changes for Parts A and B are available in the Federal Register:
- 2024 Part B premium, deductible, and coinsurance rates
- 2024 Part A premium
- 2024 Part A deductible and coinsurance rates
Input Needed: Increasing support and equity in child welfare system
The Administration for Children and Families has released two proposed rules and one final rule that will support kinship caregivers, protect LGBTQI+ children in foster care, and expand access to legal representation for children and families in the child welfare system. These changes will help keep families together and increase equity in the child welfare system.
Final Rule: Kinship foster care
The final rule announced by ACF makes it easier for family members such as grandparents, aunts, and uncles to become caregivers when a child in their family enters foster care. Previously, all foster family homes were required to meet the same licensing standards, regardless of whether the foster family home was a kin or non-kin placement, creating unnecessary barriers to kinship care.
This new rule, which takes effect November 27, allows child welfare agencies to adopt simpler licensing or approval standards for all kin foster family homes. The rule also allows states to provide additional flexibilities, such as extending the age limits for kinship foster care providers. This will allow more older adult family members to become caregivers when a child in their family enters foster care.
Proposed Rule: Supporting LGBTQI+ youth
ACF also released a proposed rule that would require that child welfare agencies ensure each child in their care who identifies as LGBTQI+ receive a safe and appropriate placement and services that help them thrive. The proposed rule would require that caregivers for LGBTQI+ children are properly and fully trained to provide for the needs of the child related to the child’s self-identified sexual orientation, gender identity, and gender expression as well. These changes are important because LGBTQI+ youth face worse outcomes in foster care, including poor mental health, higher rates of homelessness, and discrimination just because of who they are.
Proposed Rule: Access to legal representation
Finally, ACF released a proposed rule that would expand access to legal representation for children in foster care, parents, and kinship caregivers by allowing state and tribal child welfare agencies to use federal funds to provide legal services.
The rule would allow child welfare agencies to use federal funds to help cover the costs of providing access to an attorney during civil legal proceedings when doing so would support a child’s needs - for example by helping to secure stable housing, securing public benefits such as Medicaid, or establishing custody or guardianship to prevent the unnecessary removal of a child from the home.
Children and parents with disabilities are overrepresented in the foster care system. Children with disabilities are also institutionalized at higher rates and for longer periods of time than children without disabilities and parents with disabilities have high rates of termination of parental rights. Providing access to legal representation can help keep these families together and provide them with supports they need.
$45 million in grants awarded to expand access to care for people with Long COVID
The Agency for Healthcare Research and Quality announced nine grant awards of $1 million each for up to five years to support existing Long COVID clinics across the country.
The Long COVID clinics supported by these awards will focus on increasing access to care, improving person-centered care coordination, expanding multidisciplinary networks and behavioral health support, and expanding social support services, particularly for underserved, rural, vulnerable, and minority populations that are disproportionately impacted by the effects of Long COVID. Some of the ways they will do this include:
- Increasing Long COVID care access by expanding in-person and virtual visit capacity, establishing new satellite clinics, and growing provider-based referrals through a coordinated education series;
- Adding dedicated care coordination, social services, language interpretive staff, and group programs for people with Long COVID; and
- Integrating dedicated behavioral health staff and implementing behavioral health and rehabilitation group support programs.
Final rule requires national reporting of standardized Medicaid and CHIP quality measures to improve quality and advance health equity
CMS released a final rule to require reporting of standardized quality measures in Medicaid and the Children's Health Insurance Program. Starting in 2024, states will need to report three different quality measure sets annually:
- Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP,
- Behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid, and
- Core Sets of Health Home Quality Measures for Medicaid.
States will be required to report data for more measures over time as well as to separating that data out by categories such as age or disability. This will help CMS identify opportunities to improve the provision of high-quality person-centered health care and reduce health disparities among the millions of people enrolled in Medicaid and CHIP.
CMS letter to states on accurate automatic renewals for Medicaid and CHIP
As we’ve discussed before, now that the COVID-19 public health emergency is over, all states are beginning to resume their regular processes for renewing individuals’ Medicaid and CHIP coverage. This means everyone with Medicaid or CHIP coverage will be going through the renewal process in the coming months.
CMS sent a letter to states requiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or CHIP during this renewal process even if they are still eligible for coverage. If states do have an eligibility systems issue, they are required to immediately act to correct the problem and reinstate coverage.
CMS did this because it believes that eligibility systems in a number of states are programmed incorrectly and are conducting automatic renewals at the family-level and not the individual-level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and CHIP.
RSA awards nearly $199 million for demonstration projects to improve career opportunities for students with disabilities
The Department of Education’s Rehabilitation Services Administration (RSA) will fund 20 model demonstration projects to improve career opportunities for students with disabilities after high school. The funding supports collaborative partnerships between state vocational rehabilitation agencies, state and local educational agencies, and Centers for Independent Living to help individuals with disabilities seamlessly transition to life after high school, preparing them for independent living, competitive integrated employment ,and community integration.
HHS launches Environmental Justice Community Innovator Challenge
HHS launched the Environmental Justice Community Innovator Challenge to support disadvantaged communities and Tribes facing the brunt of environmental injustices, including health harms due to climate change. This challenge seeks to highlight community-level solutions to address health inequities.
HHS invites entries on all efforts to advance environmental justice, including:
- Development or implementation of innovative and effective community-driven strategies to address health disparities in communities that are disproportionately impacted by environmental hazards including those related to climate change, and the cumulative impacts of environmental and other stressors.
- Novel approaches to addressing the mental health impacts of environmental and climate change-related hazards and other cumulative stressors, especially among children and youth.
- Effective partnerships between community-based or Tribal organizations and other civil organizations, such as faith-based, health care, public health, and educational organizations, to address environmental and climate change-related hazards and support community resilience.
- Innovative approaches to building capacity in community-based or Tribal organizations on project planning, needs assessment, budgeting, engagement with community members, and grant application writing, to address environmental and climate change-related hazards as drivers of health disparities.
- Application of publicly-available data tools (i.e., Environmental Justice Index, Climate and Economic Justice Screening Tool, EJScreen) to identify signals or patterns of inequity in the distribution of environmental and climate change-related hazards, and to support measures of community resilience and research around the effectiveness of exposure mitigation efforts on human health.
The challenge has two phases. Phase 1 will focus on design of concept or development of approach. Entries for Phase 1 will be accepted until January 30, 2024. Phase 2 will focus on small-scale testing or implementation. Entries for Phase 2 will begin in Spring 2024.
ICYMI: Proposed regulations for APS programs
ACL is seeking input on a proposed rule to establish the first-ever federal regulations for adult protective services (APS) programs. The proposed rule seeks to improve consistency and quality of APS services so that they better meet the needs of adults who experience, or are at risk of, maltreatment.
Visit our webpage for a summary of the rule and key provisions. A recording of an informational webinar also is available.
Comments can be submitted online or by mail until November 13.
ICYMI: HHS proposes to strengthen protections against discrimination based on disability
The HHS Office for Civil Rights has proposed a rule that would update regulations implementing Section 504 of the Rehabilitation Act of 1973, which prohibits disability discrimination by recipients of federal funding.
Read our blog on the proposed rule for more on the key provisions in the proposal and why these updates are so important.
Comments can be submitted online or by mail until November 13.
ICYMI: 988 Suicide & Crisis Lifeline adds American Sign Language services for Deaf and Hard of Hearing callers
HHS announced that the 988 Suicide & Crisis Lifeline added nationwide American Sign Language (ASL) services for people who are Deaf and Hard of Hearing, as part of ongoing efforts to expand accessibility to behavioral health care for underserved communities.
The 988 Lifeline is a network of more than 200 state and local call centers supported by HHS through SAMHSA for anyone looking for help with suicide, mental health, and substance use-related crises. Adding ASL services to the 988 Lifeline is critical to meet the behavioral health needs of people who are Deaf and Hard of Hearing.
To connect directly to a trained 988 Lifeline counselor in ASL, callers who are Deaf, DeafBlind, DeafDisabled, Hard of Hearing, and Late-Deafened can click the "ASL Now" button on 988lifeline.org and follow the prompts. Direct dialing to 988 from a videophone will be available in the coming weeks, and in the meantime, ASL callers can call 1-800-273-TALK (8255) from their videophone to reach ASL services.