Policy Round Up: Medicaid eligibility, Long COVID, Medicare Rx Payment Plans, and more

April 2, 2024

Vicki Gottlich, Deputy Administrator for Policy and Evaluation

In this policy round up:

Medicaid and CHIP: Final rule streamlines enrollments, renewals
Medicare Prescription Payment Plan:
- CMS finalizes first program guidance
- Input needed on model materials (comments due 4/29)
HHS report provides update on Long COVID work
Medicare Savings Programs: Revised CMS instructions for states on eligibility and enrollment processes
Behavioral health and substance use care:
- CMS guidance to expand availability of Medicaid funding for behavioral health care providers and nurse advice lines
- HHS finalizes new rule on integrated care and confidentiality for patients with substance use conditions
- New SAMHSA funding opportunities to increase capacity for behavioral health services
Affordable Connectivity Program wind-down resources
ACF finalizes rule addressing child care costs for more than 100,000 families receiving subsidies

Medicaid and CHIP: Final Rule Streamlines Enrollments, Renewals

The Centers for Medicare & Medicaid Services (CMS) finalized a rule that simplifies applications, verifications, enrollment, and renewals for health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The rule:

Allows the projection of predictable costs for home and community-based services. The projection of predictable costs has long been allowed for institutional services and allows a state to deduct anticipated medical expenses from a person’s countable income.
Prohibits states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and people with disabilities.
Eliminates annual and lifetime limits on children’s coverage in CHIP.
Ends the practice of locking children out of CHIP coverage if a family is unable to pay premiums.
Eliminates waiting periods for CHIP coverage so children can access health care immediately.
Improves the transfer of children seamlessly from Medicaid to CHIP when a family’s income rises.
Requires states to provide all individuals with at least 15 days to provide any additional information when applying for the first time and 30 days to return documentation when renewing coverage.

CMS will be discussing the rule’s impact on Medicaid and CHIP renewals during a webinar tomorrow, April 3, at 12:00 PM ET.

Medicare Prescription Payment Plan: CMS Finalizes First Guidance

CMS has finalized part one of its guidance on the Medicare Prescription Payment Plan, which gives people with Medicare prescription drug coverage (Medicare Part D) the option to pay out-of-pocket costs in monthly payments spread out over the year, starting in 2025.

The guidance focuses on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and build the necessary infrastructure for successful implementation. It addresses topics including:

Identifying Medicare Part D enrollees likely to benefit from the program.
The opt-in process for Part D enrollees.
Program participant protections.
The data collection needed to evaluate the program.

For more information on the guidance, see this fact sheet.

Input Needed: Medicare Prescription Payment Plan Model Materials

Along with the guidance discussed above, CMS also is seeking input on a proposed information collection for the Medicare Prescription Payment Plan. The information collection includes model materials for Medicare Part D plan sponsors to use when communicating to enrollees about the program. The draft materials are available online for public review and feedback.

The materials are meant to provide standardized and consistent language for potential and active program participants, regardless of which Part D plan they may be enrolled in. CMS will require Part D plans to provide these notices, as appropriate, to Part D enrollees.

Comments can be submitted online or by mail until April 29.

HHS Report Provides Update on Long COVID work

Although many people with COVID-19 get better within weeks, some people continue to experience symptoms that can last months or years after first being infected, or may have new or recurring symptoms at a later time. This can happen to anyone who has had COVID-19, even if the initial illness was mild. People with this condition are sometimes called “long-haulers,” and this condition is commonly known as “Long COVID.”

HHS’ Office of Long COVID Research and Practice has published a report outlining its current perspectives on Long COVID and the activities the federal government is undertaking to meet the challenge of Long COVID. This update builds on the National Research Action Plan on Long COVID and the Services and Supports for the Longer-term Impacts of COVID-19 Report, both published in August 2022, and lays out how the federal government is meeting the goals and objectives detailed in those reports.

The federal government continues to play a critical role in this work but partnerships with patients, advocates, clinicians, researchers, and industry are essential to meet the current and future needs of people with Long COVID. The report highlights the importance of partnerships in public education, research, support services, and more.

Medicare Savings Programs: Revised CMS Instructions for States on Eligibility and Enrollment

CMS released updated instructions for states to implement Medicare Savings Programs (MSPs). The updates follow a new rule CMS finalized last fall to streamline enrollment in MSPs before upcoming compliance deadlines.

The final rule simplifies MSP eligibility and enrollment processes by:

Automatically enrolling most Medicare-enrolled SSI recipients into the Qualified Medicare Beneficiary (QMB) group, which covers Medicare premiums and cost-sharing such as deductibles and copays;
Making better use of the Medicare Part D Low Income Subsidy (LIS) program to enroll people who are eligible in the MSPs; and
Reducing documentation requirements for MSP applicants.

The compliance deadline for automatic enrollment in the QMB group is October 1. The compliance deadline for making better use of the LIS program and reducing documentation requirements is April 1, 2026.

CMS Guidance to Expand Availability of Medicaid Funding for Nurse Advice Lines and Behavioral Health Care Providers

CMS has released new guidance aimed at expanding access to behavioral health care and nurse advice lines.

The guidance expands the pool of behavioral health care providers eligible for enhanced Medicaid funding to include Masters of Social Work and other master’s-level behavioral health care providers, such as marriage and family therapists as well as mental health counselors. The goal is to ensure Medicaid beneficiaries have access to a workforce with the expertise to meet their mental health and substance use disorder (SUD) needs.

The guidance also allows federal funds to be used to support nurse advice lines. Nurse advice lines are telephone services usually available 24 hours a day, 7 days per week that allow Medicaid beneficiaries to call for advice about appropriate medical action to take when a situation arises requiring medical attention. The telephone lines provide support and guidance to beneficiaries for non-emergency situations by assessing and triaging symptoms, using clinical judgment to offer care advice and referrals, and educating beneficiaries about their health. In the event that a caller presents information that suggests an emergency, In emergency situations, nurse advice lines direct callers to seek emergency assistance, such as by calling 911 or the 988 Suicide and Crisis Lifeline or going to the nearest emergency department. Nurse advice lines can help support states in addressing workforce capacity and provide access to an initial source of non-emergency care, including for behavioral health. Since the start of the COVID-19 pandemic, , nurse advice lines also have been an important tool to support ongoing access to care—especially in rural communities.

HHS Finalizes New Rule on Integrated Care and Confidentiality for Patients With Substance Use Conditions

HHS released a new rule that increases coordination among providers treating patients for substance use disorders (SUDs), strengthens confidentiality protections, and enhances integration of behavioral health information with other medical records.

The rule modifies the Confidentiality of SUD Patient Records regulation, which protects the privacy of patients’ SUD treatment records. These changes help align the regulation with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules, which protect sensitive patient health information.

Some of the major changes in this rule include:

Permitting patients to give consent once for all future uses and disclosures of records for treatment, payment, and health care operations.
Providing new rights for patients to get an accounting of disclosures and to request restrictions on certain disclosures.
Expanding prohibitions on the use and disclosure of records in civil, criminal, administrative, and legislative proceedings.
Providing HHS enforcement authority, including the potential imposition of civil money penalties for violations.

For more information, check out this fact sheet. The new rule will take effect on April 16.

New SAMHSA Funding Opportunities To Increase Capacity for Behavioral Health Services

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced funding opportunities totaling $36.9 million programs supporting behavioral health services across the country.

The grant funding opportunities will help provide training and technical assistance for the substance use prevention workforce and community partners, SUD education for students in health professions programs, funding for evidence-based interventions, and support for mental health consumer-run organizations.

For more information on the grant funding opportunities, check out these grant announcements:

Affordable Connectivity Program Wind-Down Resources

The Affordable Connectivity Program is an FCC benefit program that helps ensure that households can afford broadband by providing a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying Tribal lands.

Due to a lack of funding, the program stopped accepting new applications and enrollments on February 7, 2024. The last fully funded month of the program is April 2024. Households are encouraged to consult their internet company to learn more about how the end of the ACP will impact their internet service and bill.

FCC also reminds consumers that the Lifeline program provides a phone and Internet service discount of $9.25/month or $34.25/month on qualifying tribal lands, for households that meet Lifeline eligibility criteria

This FCC page has a variety of wind-down resources, including:

Fact Sheet: ACP Wind-Down Overview| Hoja informativa sobre el fin del programa ACP
ACP & Lifeline FAQs| ACP y Lifeline: Preguntas Frecuentes
ACP Wind Down Consumer Webinar: Video| Slides

ACF Finalizes Rule Addressing Child Care Costs for More Than 100,000 Families Receiving Subsidies

The Administration for Children and Families (ACF) has finalized a rule that amends the Child Care and Development Fund (CCDF) regulations. As we have discussed previously, the new rule seeks to help more families, including those with children with disabilities, access the child care they need.

The rule:

Limits the amount that families participating in the Child Care & Development Block Grant (CCDBG) program pay to seven percent of their household income.
Encourages states to eliminate co-payments entirely for families of children with disabilities, children experiencing homelessness, children in foster care, children in Head Start, and families at or below 150% of the federal poverty level.
Makes it easier for families to apply for and receive child care assistance if they have already demonstrated eligibility for another benefit program.

The new rule goes into effect on April 30.