In this Policy Round-Up:
- Input Needed: Initial Guidance for Medicare Prescription Drug Inflation Rebate Program
- CMS Issues Important Medicaid Drug Rebate Program Reminders for States
- Input Needed: Strategies to Meet Critical Workforce Needs Across Industries
- Input Needed: Proposed Rule to Increase Transparency of Nursing Home Ownership
- Input Needed: Proposed Rule Omitting Food from In-Kind Support and Maintenance Calculations
- HUD Issues Updated Guidance to Enhance Use of Supportive Services Programs at Properties for Low-Income Older Adults
- SECURE 2.0 Signed Into Law
- Release of Informational Bulletin on 2023 Federal Poverty Level Standards
- ICYMI: CMS proposes benefit expansion for power seat elevation equipment
Input Needed: Initial Guidance for Medicare Prescription Drug Inflation Rebate Program
On February 9, the Centers for Medicare & Medicaid Services (CMS) released initial guidance and a fact sheet on a new prescription drug inflation rebate program, which, for the first time, requires drug companies to pay rebates to Medicare when their prescription drug prices increase faster than the rate of inflation for certain drugs covered by Medicare Part B and Part D. For Medicare Part B, the program will also reduce cost-sharing by beneficiaries for those drugs.
CMS is seeking comments on the guidance and will release revised guidance later this year based on those comments. Some of the topic areas CMS is requesting comments on include:
- the process to determine the number of drug units for rebatable drugs;
- reduction of rebate amounts for certain Part B and Part D rebatable drugs in shortage and in cases of severe supply chain disruptions;
- the process to impose civil monetary penalties on manufacturers of Part D rebatable drugs that fail to pay rebates; and
- assuring accuracy of the inflation rebate payments.
Comments on the guidance can be submitted by email until March 11, 2023. Detailed instructions can be found in the Part B and Part D guidance.
CMS Issues Important Medicaid Drug Rebate Program Reminders for States
Earlier this month, CMS issued a notice to states about the Medicaid Drug Rebate Program, reminding them of the following Medicaid Drug Rebate reporting and certification requirements:
- States must report certain data about their value-based purchasing (VBP) arrangements under a Centers for Medicare & Medicaid Services (CMS) authorized supplemental rebate agreement by March 1, 2023.
- States must certify their state drug utilization data (SDUD) records submitted after January 1, 2022.
The notice includes information on how to submit the data report and certify state drug utilization data, as well as resources to help states meet the requirements.
Input Needed: Strategies to Meet Critical Workforce Needs Across Industries
The Department of Labor (DOL) is seeking public input on current and planned local and regional sector strategies and partnership models that address workforce needs across industries, including the direct care workforce, which has been struggling with a labor shortage for years. Comments can be submitted online until March 24, 2023.
The Request for Information (RFI) requests comments from stakeholders involved directly and indirectly in economic and workforce development. This will inform efforts in:
- Improving understanding of promising practices and policy, program, and resource needs of local and regional economic development areas, with respect to sector strategies.
- Developing sustainable and scalable sector strategies to meet local and regional sector needs for skilled workers in quality jobs.
- Meeting broader Administration objectives, such as equity and the inclusion of historically marginalized populations, and responsiveness to the needs of businesses and the economy in critical industries during and beyond the pandemic.
Input Needed: Proposed Rule to Increase Transparency of Nursing Home Ownership
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would require the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities and Medicaid nursing facilities. Comments can be submitted online or by mail until April 14, 2023.
The Biden-Harris Administration recently released a plan for nursing home reform, and CMS has increasingly been concerned about the quality of care at nursing homes, especially those owned by private equity companies and other types of investment firms. Advocates have also long called for greater ownership transparency, in part, to know who is ultimately accountable for the care and services that are the responsibility of nursing homes, which this proposed rule aims to address. The proposed rule would, among other things, require reporting organizational structure of “disclosable parties” and a description of the relationship. Disclosable parties include persons or entities that have some control over operations, lease or sublease property, or provide certain types of services to the facility.
Input Needed: Proposed Rule Omitting Food from In-Kind Support and Maintenance Calculations
The Social Security Administration (SSA) released a proposed rule that would no longer consider food expenses when calculating in-kind support and maintenance to determine benefits for people who receive Supplemental Security Income (SSI). SSA reduces the amount of SSI for which an individual is eligible based on the receipt of in-kind support and maintenance.
An SSI applicant or beneficiary receives in-kind support and maintenance when someone else provides or contributes towards their food or shelter. In those cases, the SSA considers how much someone else is contributing to that person’s food or shelter costs in determining that person’s SSI benefits. Removing food from in-kind support and maintenance calculations would simplify benefit calculations for the many low-income people with disabilities and older adults who receive SSI and lower or eliminate benefit reductions for some.
In-kind support and maintenance benefit calculations vary depending on whether someone lives on their own but receives help from someone else with food and shelter costs or lives with someone else and receives food and shelter from that person or other members of the household. SSA proposes to keep food-related questions only for the purposes of determining which category someone falls into, not for the purposes of determining someone’s benefits. SSA is soliciting comments on alternative ways to make this determination. In addition, SSA also seeks comments on how to make the rule easier to understand.
Comments can be submitted online or by fax or mail until April 17, 2023.
HUD Issues Updated Guidance to Enhance Use of Supportive Services Programs at Properties for Low-Income Older Adults
The Department of Housing and Urban Development (HUD) has issued guidance to reinforce the importance of supportive service programs and the many allowable uses of supportive services funds to support independent living for older adults. Supportive services include services that may be provided to an individual resident, like meal services, housekeeping assistance, and personal assistance, or services that have to be available to the entire community, like transportation, health-related services, and fees for education and outreach to protect residents from telemarketing and internet fraud and identity theft.
The guidance explains the purpose of supportive services funds and how they can be used, along with the requirements and process for requesting approval to include these funds in the annual operating budget for project rental assistance contracts. It also reiterates requirements for Supportive Services Plans and components HUD encourages property owners and agents to include in Supportive Services Plans, including how the supportive services needs of individual residents and the resident community as a whole are assessed, and how they assist individual residents to identify and access local, state, and federal benefits or community-based services that support independent living.
SECURE 2.0 Signed Into Law
On December 29, the Setting Every Community Up for Retirement Enhancement Act (known as SECURE 2.0) was signed into law. The Act will improve retirement security for retirees and for workers in a number of ways, including:
- Creating a retirement savings lost and found
- For people who have changed jobs, it can often be difficult to find their retirement plan when they need it. Under the Act, the Department of Labor (DOL) will create and maintain an online searchable website to help people find their plans.
- New protections for people facing “recoupment”
- When retirement plans accidentally overpay individuals, they can demand repayment (called “recoupment”), often with interest. Under SECURE 2.0, plans can no longer seek repayment if they do not discover the mistake within three years of the first overpayment and cannot reduce future benefits by more than ten percent.
- Enhancing the saver’s tax credit to help low- and moderate-income workers save for retirement
- Under SECURE 2.0, for low- and moderate-income workers who contribute to an IRA or to a 401(k) and similar plans permitting employee contributions, the government will now provide a direct matching contribution.
ACL’s Pension Counseling & Information Program is also available to assist older adults in accessing information about their retirement benefits and help them to negotiate with former employers or pension plans for due compensation. The program has information, resources, and tools to help individuals navigate their financial choices in retirement.
Release of Informational Bulletin on 2023 Federal Poverty Level Standards
Last month, the Center for Medicaid and CHIP Services (CMCS) released an informational bulletin on updated 2023 federal poverty level standards . These standards are an important piece of eligibility criteria for programs such as Medicaid and the Children’s Health Insurance Program (CHIP).
The bulletin also includes the 2023 Dual Eligible Standards chart that displays the new standards for the Medicare Savings Program categories. “Dual eligible” refers to people who are eligible for both Medicare and Medicaid. Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid and coverage for additional services Medicaid covers that Medicare does not.
ICYMI: CMS proposes benefit expansion for power seat elevation equipment
On February 15, CMS released an announcement on a proposed National Coverage Determination (NCD) decision that would expand coverage for power seat elevation equipment on certain power wheelchairs to people receiving Medicare. The proposed NCD decision memorandum is available to review here. The 30-day comment period will close on March 17, 2023.