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Policy Round Up: OTC Hearing Aids, CDC’s Prescribing Guideline for Opioids, Surgeon General’s Framework for Mental Health in the Workplace, and more

December 5, 2022
Vicki Gottlich, Deputy Administrator for Policy and Evaluation

In this policy round up:

  • Last chance:  Comments due 12/6 on CMS RFI on Nat’l Directory of Health Care Providers and Services
  • Cheaper Hearing Aids Now in Stores
  • CDC Releases Clinical Practice Guideline for Prescribing Opioids
  • U.S. Surgeon General Releases New Framework for Mental Health & Well-Being in the Workplace
  • CMS Finalizes Policies to Simplify Medicare Enrollment and Expand Access to Coverage for Certain Immunosuppressive Drugs

Last chance: Comments due 12/6 on CMS RFI on Nat’l Directory of Health Care Providers and Services

CMS is seeking feedback on the potential creation of a directory with information on health care providers and services. Feedback can be submitted by mail or online until tomorrow (December 6).

The directory could serve as a centralized data hub, containing the most accurate, up-to-date, and validated data in a publicly accessible index. This could help people find and compare providers, as well as more easily identify which providers meet their needs and preferences. This is especially useful for older adults and people with disabilities who often have accessibility and language needs.

This would not replace current CMS-maintained data systems, like Medicare Care Compare. Instead, the directory would be a tool that works in combination with these systems to streamline and improve the processes for collecting, maintaining, and presenting information in a more user-friendly manner.

The RFI seeks input on:

  • Topics related to the establishment of a national directory, including whether it would be helpful to include data elements such as provider languages spoken other than English, specific office accessibility features for people with disabilities and/or limited mobility, accessible examination or medical diagnostic equipment, or a provider's cultural competencies;
  • Key considerations related to data submission and maintenance;
  • Technical considerations;
  • The current state of healthcare provider directories and steps that could or should be taken if CMS establishes a national directory;
  • Feasibility of a phased approach to implementation and potential opportunities to build stakeholder trust and adoption along the way; and
  • Risks, challenges, and prerequisites associated with implementing such a directory.

Cheaper Hearing Aids Now in Stores

Last month, in response to an executive order issued by President Biden, the Food and Drug Administration (FDA) issued a final rule to lower the cost of hearing aids for the nearly 30 million Americans who have hearing loss.

The new rule allows adults with mild-to-moderate hearing loss to buy hearing aids at a store or online without a prescription, exam, or audiologist fitting. The FDA estimates this could lower average costs by as much as $3,000 per pair. Eliminating the need for these additional steps to obtain hearing aids will also reduce not just cost, but barriers for those who may not have access to an audiologist. Retailers across the country, including CVS, Walgreens, Walmart, and others, are now selling over-the-counter hearing aids. For more on the options available, see this fact sheet.

CDC Releases Clinical Practice Guideline for Prescribing Opioids

On November 4, the Centers for Disease Control and Prevention (CDC) released an update to its clinical practice guideline for prescribing opioids, which was last issued in 2016. The updated guideline provides more flexibility in its recommendations, centering clinical judgment and communication between clinicians and patients, a change the disability community had strongly advocated for.

The update addresses management of subacute painful conditions and clarifies recommendations that apply to patients who are being considered for initial treatment with prescription opioids and those who have already been receiving opioids as part of their ongoing pain management treatment.

The updated guideline also emphasizes the importance of individualized person-centered care. It underscores that pain management should include consideration of a person’s physical health, behavioral health, long-term services and supports, expected health outcomes and well-being needs.

Additionally, it recognizes that older adults can be at risk for inadequate pain treatment and outlines best practices when it comes to prescribing opioids to them, including implementing interventions to mitigate common risks and educating older adults receiving opioids to avoid medication-related behaviors that increase risk, such as saving unused medications.

U.S. Surgeon General Releases New Framework for Mental Health & Well-Being in the Workplace

On October 20, the U.S. Surgeon General released a new Framework for Mental Health & Well-Being in the Workplace. The report outlines five essentials for workplace mental health and well-being to help organizations develop, institutionalize, and update policies, processes, and practices that best support the mental health and well-being of all workers.

Among those, the framework recommends making Diversity, Equity, Inclusion, and Accessibility (DEIA) norms, policies, and programs a priority. This includes considerations for people with disabilities to ensure equitable access to employment, as well as workplace participation, accommodations, and modifications. To achieve this, framework points to resources employers and current and prospective employees can use, including the Job Accommodation Network (JAN) and Administration for Community Living’s Americans with Disabilities Act National Network, which provide free training and resources for employees, employers, and job applicants.

CMS Finalizes Policies to Simplify Medicare Enrollment and Expand Access to Coverage for Certain Immunosuppressive Drugs

On October 28, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that will simplify Medicare enrollment rules and extend coverage of immunosuppressive drugs for certain beneficiaries.

CMS also published a fact sheet explaining the key provisions of the rule. Among them:

  • Reduced delays in coverage.  People who enroll during the general enrollment period or during the last three months of their initial enrollment period will now have Medicare coverage beginning the month immediately after their enrollment.
  • New special enrollment periods, which allow people to enroll in Medicare Part B coverage without a late-enrollment penalty if they missed a Medicare enrollment period due to: 
    • Emergency or disaster
    • Health plans or employers misrepresenting or providing incorrect information
    • Incarceration
    • Other exceptional conditions
  • There also will now be a special enrollment period to allow people to enroll in Medicare after termination of Medicaid eligibility.
  • Immunosuppressive drug coverage will now be available indefinitely after a kidney transplant for people who have Medicare coverage based on End-Stage Renal Disease, if they do not have (or plan to enroll in) other types of health coverage.
  • The rule simplifies state administration of Medicare Savings Programs (MSPs), through which states cover Medicare premiums and cost sharing for low-income beneficiaries.

CMS releases new resource for states on ending Medicaid coverage in the optional COVID-19 group

Last month, the Centers for Medicare & Medicaid Services (CMS) released a new resource for states to use as they prepare for the eventual end of the COVID-19 public health emergency (PHE).

During the PHE, some states expanded access to Medicaid coverage through an optional COVID-19 eligibility group to ensure people who would otherwise be uninsured could access critical COVID-related services. When the PHE ends, this special eligibility will end, as well. States will need to redetermine eligibility for those beneficiaries to determine if they’re eligible for Medicaid on another basis. This resource provides states with strategies for doing so, along with advice on planning for unwinding following the PHE.

In a March a letter to state health officials, CMS  provided states flexibility to prioritize work for certain populations and distribute renewals across the unwinding period. That letter recommends that states initiate no more than 1/9 of their total caseload of Medicaid and CHIP renewals in a given month during the unwinding period.

However, because coverage for the optional COVID-19 group will end as of the last day of the PHE, CMS has advised states in this new resource that they do not need to include optional COVID-19 group beneficiaries in their total caseload for purposes of ensuring they are initiating renewals for no more than 1/9 of their total Medicaid and CHIP caseload in a given month.

States also do not need to include the optional COVID-19 group in their baseline and monthly data eligibility and enrollment unwinding data reports. CMS will track optional COVID-19 group enrollment numbers and application processing data through existing CMS data collection efforts.

Last modified on 01/20/2023

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