CMS announces new policy guidance for states to test community engagement for able-bodied adults

PRESS RELEASE FOR IMMEDIATE RELEASE Jan 11, 2018  Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries                                  CMS announces new policy guidance for states to test community engagement for able-bodied adults  Will support states helping Medicaid beneficiaries improve well-being and achieve self-sufficiency CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women. The new policy guidance sent to states is intended to help them design demonstration projects that promote the objectives of the Medicaid program and are consistent with federal statutory requirements. To achieve the objectives of Medicaid, state programs should be designed to promote better physical and mental health. “Medicaid needs to be more flexible so that states can best address the needs of this population. Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” said Seema Verma, CMS Administrator. To date, CMS has received demonstration project proposals from 10 states that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. “Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency,” said Verma. Announcement of the new guidance delivers on the commitment made by Administrator Verma in her address to state Medicaid directors last November, to “turn the page” in the Medicaid program and give states more freedom to design innovative programs that achieve positive results for the people they serve and to remove bureaucratic barriers that block states from achieving this goal. Criteria and Parameters of the New Policy Guidance CMS has identified a number of issues for states to consider in the development of proposals to promote work and other community engagement among working-age, non-pregnant Medicaid beneficiaries not eligible for Medicaid on the basis of a disability. Meeting work and community engagement requirements should take into consideration areas of high unemployment or caregiving for young children or elderly family members. States will therefore be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance these services. CMS will support state efforts to align Medicaid work and community engagement requirements with SNAP or TANF requirements, where appropriate, as part of this demonstration opportunity. Aligning requirements across these programs may streamline eligibility and reduce the burden on both states and beneficiaries and help beneficiaries succeed in meeting their work and community engagement responsibilities.     States must also fully comply with federal disability and civil rights laws and ensure that all individuals with disabilities have the necessary protections to ensure that they are not inappropriately denied coverage. States will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements. Administrator Verma cited the Administration’s firm commitment to combat our nation's opioid crisis and the letter outlines that CMS will require states to make reasonable modifications for individuals with opioid addiction and other substance use disorders. These modifications may include counting time spent in medical treatment toward an individual’s community engagement requirements or exempting individuals participating in intensive inpatient or outpatient medical treatment, as well as supporting other state efforts. CMS also encourages states to consider a range of activities that could satisfy work and community engagement requirements. States should ensure that career planning, job training, referral, and volunteering opportunities considered to meet the community engagement requirement, and job support services offered in connection with the requirement, take into account people’s employability and potential contributions to the labor market. “States have the opportunity to help individuals improve and enhance the skills that employers truly value,” said Verma. “People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes.” Medicaid Demonstration Projects Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects determined by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. Demonstrations, which give states additional flexibility to design and improve their programs, are also designed to evaluate state-specific policy approaches and better serve Medicaid populations. Administrator Verma also announced that CMS has updated Medicaid.gov to give states a clearer indication of how their reform strategies under section 1115 should align with a core objective of the Medicaid program: serving the health and wellness needs of the nation’s vulnerable and low-income individuals and families. The revised website content signals a new, broader view of these demonstrations in which states can focus on evidence-based approaches that drive better health outcomes, and quality of life improvements, and support upward mobility and self-sufficiency. On March 14, 2017, the Department of Health and Human Services and CMS issued a letter to the nation’s governors affirming the federal government’s partnership with states to improve the integrity and effectiveness of the Medicaid program for low-income people with Medicaid. The letter encourages states to bring forward proposals grounded in ideas that reflect the dynamics and culture of a state. “This new guidance paves the way for states to demonstrate how their ideas will improve the health of Medicaid beneficiaries, as well as potentially improve their economic well-being,” said Brian Neale, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services.   To view a copy of the SMD letter # 18-002, please click here.                                                                                  # Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

New MCBS Data Highlight Posted

Important News... New MCBS Data Highlight Posted – “Prevalence and Health Care Expenditures among Medicare Beneficiaries Aged 65 Years and Over with Heart Conditions”.  Heart disease has been the leading cause of death for Americans aged 65 years and over for the past several decades. Heart conditions as a category represent one of the most common, burdensome, and expensive health problems among the Medicare population. Using data from the 2013 Medicare Current Beneficiary Survey (MCBS), this report presents the prevalence and impact (utilization, total cost of care, and out-of-pocket health care costs) of having a heart condition on the Medicare population aged 65 years and over. To view this data highlight, please visit the Data Briefs and Tutorials section of the MCBS website at https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Data-Briefs.html. MCBS users interested in the MCBS Public Use data files, please visit the CMS MCBS PUF Research page (https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/MCBS-Public-Use-File/index.html) to get more information about the MCBS PUF. Statement on Encryption and Compression of Data MCBS data products are delivered in encrypted zipped format, using SecureZIP® by PKWARE, Inc. Unzipping a file through controlled email servers often results in messages regarding incorrect password attempts and is not advised. Please save MCBS zipped data products to a hard drive and open in desktop mode to ensure proper unzipping and file extraction. You can read more about SecureZIP® using their convenient FAQ and support pages. SecureZIP®- Version 14.00.0023 FAQ (Basics of Zipping and Unzipping with PKZIP and SecureZIP®) http://www.pkware.com/support/desktop/faqs PKWARE, Inc. http://www.pkware.com/support You're getting this message because you subscribed to get email updates from the Centers for Medicare & Medicaid Services (CMS). Update your subscriptions, modify your password or email address, or stop subscriptions at any time on your Subscriber Preferences Page. You will need to use your email address to log in. If you have questions or problems with the subscription service, please contact subscriberhelp.govdelivery.com. This service is provided to you at no charge by Centers for Medicare & Medicaid Services (CMS). This email was sent to john.dubas@premiersmi.com using GovDelivery Communications Cloud 7500 Security Boulevard · Baltimore MD 21244

CMS Announces Additional Special Enrollment Periods to help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands

CMS NEWS FOR IMMEDIATE RELEASE January 17, 2018  Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries CMS Announces Additional Special Enrollment Periods to help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands Agency provides extended special enrollment periods for 2018 Medicare and Exchange coverage En español The Centers for Medicare & Medicaid Services (CMS) announced additional opportunities for individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands to enroll in Medicare health and drug plans and health coverage through the Federal Health Insurance Exchange.  CMS is providing these special enrollment periods so that certain individuals and families who were impacted can access health coverage on the Exchange and have additional time to join, drop, or switch Medicare health and prescription drug plans.  CMS announced initial special enrollment period opportunities in September, this extends these opportunities through March 31, 2018. “CMS is committed to making it as easy as possible for individuals and families whose lives have been disrupted by these hurricanes to access the healthcare coverage they need during this difficult time,” said CMS Administrator Seema Verma. “The impacts of a hurricane can last for months. These special enrollment periods provide the necessary flexibility for our beneficiaries to obtain and maintain coverage while dealing with the lingering aftermath of the storms.  We will continue to monitor the circumstances in Puerto Rico and the U.S. Virgin Islands and will take additional action as necessary.” CMS established the following special enrollment periods to support individuals impacted by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands:  Federal Health Insurance Exchange special enrollment period:  Individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands who relocated to a state that uses the Federal Health Insurance Exchange, but were unable to enroll during the 2018 Annual Open Enrollment Period or any other special enrollment period, are eligible for an exceptional circumstance special enrollment period to enroll in 2018 Exchange coverage. Individuals in this situation may request this special enrollment period through March 31, 2018. These individuals should contact the Exchange Call Center at 1-800-318-2596 to request enrollment using this special enrollment period. Medicare special enrollment period extension:  This special enrollment period will allow individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands to enroll, dis-enroll or switch Medicare health or prescription drug plans through March 31, 2018. This special enrollment period can be used even if the beneficiary made a choice during Medicare’s fall open enrollment period. The special enrollment period can also be used for those who left Puerto Rico and would like to enroll in a local Medicare Advantage or Medicare prescription drug plan that would better meet their healthcare needs. Beneficiaries who change their permanent residence, rather than temporarily relocate, and no longer reside in their plan service area, are eligible to join a Medicare Advantage or prescription drug plan offered in the new area in which they reside through the existing residence change special enrollment period. Individuals who were displaced and return to Puerto Rico or the U.S. Virgin Islands are also eligible for the residence change special enrollment period.  Individuals in these situations may contact 1-800-MEDICARE to request enrollment using this special enrollment opportunity. For more information on special enrollment periods for the Federal Health Insurance Exchange, visit: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Territories-SEP-Guidance.pdf For more information on special enrollment period extension for Medicare, visit: https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Extension-SE-Period-PR-VI-CA-Wildfire.pdf ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts

CMS NEWS FOR IMMEDIATE RELEASE January 23, 2018 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts  Today, the U.S. Department of Veterans Affairs (VA) and Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced a partnership to share data, data analytics tools and best practices for identifying and preventing fraud, waste and abuse.  This newest partnership enhances ongoing efforts between the country’s two largest public-private health-care payment organizations to help America’s Veterans by leveraging the gains made by CMS.  “The VA-HHS alliance represents the latest example of VA’s commitment to find partners to assist with identifying new and innovative ways to seek out fraud, waste and abuse and ensure every tax dollar given to VA supports Veterans,” said VA Secretary Dr. David J. Shulkin. “This effort marks another step toward achieving President Trump’s 10-point plan to reform the VA by collaborating with our federal partners to improve VA’s ability to investigate fraud and wrongdoing in VA programs.”  CMS continues to focus on reducing and eliminating fraud, waste and abuse in Medicare, and in 2010, it established the Center for Program Integrity to help with this work. CMS estimates that its program integrity activities saved Medicare operations $17 billion in fiscal 2015. Other HHS combined efforts — including law enforcement — contributed to greater program savings. VA plans to capitalize on the advancements in analytics CMS has made by concentrating on its use of advanced technology, statistics and data analytics to improve fraud detection and prevention efforts. Additionally, in November 2017, VA invited industry experts to provide information on the latest commercial sector tools and techniques to enhance VA’s fraud detection capabilities. In April, VA will invite these industry experts to demonstrate their capabilities for detecting and preventing fraud, waste and abuse and recovering improper payments. “We have a special obligation to keep America’s promise to those who have served our country and ensure that Veterans receive high-quality and accessible health care,” said CMS Administrator Seema Verma. “CMS is sharing lessons learned and expertise to support VA to identify waste and fraud and eliminate these abuses of the public trust. Using state-of-the-art data analytics, CMS is partnering with VA to better detect and prevent wrongdoing in its programs.” By using CMS’ successes in its program integrity protocols, VA will be able to close existing gaps in its own claims payment process.  ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.

Racial and Ethnic Disparities in Mental Health Among Diverse Groups of Medicare Advantage Beneficiaries

NEW Data Highlight Volume 11 - December 2017 Racial and Ethnic Disparities in Mental Health Among Diverse Groups of Medicare Advantage Beneficiaries The CMS Office of Minority Health has released a data highlight examining the physical and mental health outcomes of Medicare Advantage beneficiaries by race and ethnicity. This highlight is one of the few analyses that (1) compares granular racial and ethnic groups in the same study, (2) is based on a nationally representative sample, and (3) focuses on mental health in older adults. Given the important role that mental health plays in overall health, this analysis makes an important contribution to our understanding of the diagnosis and treatment of mental health in older adults. Some of the findings include: ·         Relative to other races, American Indian and Alaska Native as well as Native Hawaiian and Pacific Islander beneficiaries generally reported worse mental health status across multiple indicators, including depression and depression symptoms, days of activities missed because of poor physical and mental health, and mental health functioning. ·         Among all ethnicities, multiethnic Hispanic beneficiaries generally reported worse mental health status than non-Hispanic beneficiaries or those reporting a single ethnicity. The findings suggest that viewing results for only larger race or ethnicity groups – such as Asians, Native Hawaiians and other Pacific Islanders, or Hispanics – may hide key differences, emphasizing the importance of reporting more granular racial and ethnic data. To access this data highlight, visit https://www.cms.gov/About-CMS/Agency-Information/OMH/research-and-data/information-products/data-highlights/index.html

First Half of 2017 Average Effectuated Enrollment Report

FOR IMMEDIATE RELEASE December 13, 2017  Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries First Half of 2017 Average Effectuated Enrollment Report  Effectuated Enrollment Analysis According to data as of September 15, 2017, an average of 10.1 million individuals had effectuated their coverage through June 2017, meaning that they selected a plan and paid their premium. This is approximately 200,000 fewer effectuated individuals compared to the effectuated report for the first half of 2016 and about 2.1 million below the number of plan selections at the end of 2017 open enrollment. Looking historically at Affordable Care Act trends from 2014 through 2017, we also see that a significant number of people who effectuate coverage do not stay in their plans for the full year. By June, 9.9 million individuals remained in coverage compared to the 12.2 million who selected plans. On average since 2014, more than a million enrollees per year dropped their coverage before the end of the plan year.  This report also shows that the proportion of the population that enrolls on Federal and State-Based Exchanges and qualifies for financial assistance in the form of advance premium tax credits (APTC) or cost-sharing reduction (CSR) has remained relatively stable, but the average amount of APTC per eligible individual has risen by nearly 29% when compared with the 2016 average APTC per eligible enrollee. In addition, the average amount of APTC per eligible enrollee has risen slightly (from $371.49 to $373.37) when compared with the February 2017 snapshot average APTC per eligible enrollee. This indicates that individuals who effectuated after February 2017 and who remained covered were more likely to have or receive more APTC.  Background Information The primary source for the first half of 2017 average effectuated enrollment are payment and enrollment data. Effectuated enrollment is the average number of individuals who had an active policy from January through June of 2017, and who paid their premium (thus effectuating their coverage) as of September 15, 2017. This data includes effectuated enrollment from both State-Based and Federally-Facilitated individual market Exchanges. APTC enrollment is the average number of individuals who had an active policy from January through June of 2017, who paid their premium, and who received an APTC subsidy. APTC is generally available if a consumer's household income is between 100 and 400 percent of the federal poverty level and certain other criteria are met. A consumer was defined as having an APTC if the applied APTC amount was greater than $0; otherwise, a consumer was classified as not having APTC.    CSR enrollment is the average number of individuals who had an active policy from January through June 2017, who paid their premium, and received CSRs. A CSR is generally available if a consumer is eligible for APTC, has a household income between 100 percent and 250 percent of the federal poverty level, and the individual chooses a health plan from the silver plan category.  Those who qualify have reduced out-of-pocket costs. American Indians and Alaskan Natives are eligible for CSRs under different criteria. Total Average Effectuated Enrollment and Financial Assistance by State for the First Half of 2017 State Total Enrollment APTC Enrollment Percentage of Enrollment with APTC CSR Enrollment Percentage of Enrollment with CSR Total 10,142,056 8,561,695 84% 5,814,266 57% AK 14,954 13,782 92% 6,157 41% AL 154,156 144,301 94% 117,454 76% AR 56,846 48,830 86% 32,887 58% AZ 142,502 123,391 87% 80,064 56% CA 1,346,226 1,153,203 86% 658,766 49% CO 143,509 93,403 65% 38,424 27% CT 96,438 73,193 76% 41,289 43% DC 18,349 877 5% 605 3% DE 22,433 18,841 84% 10,524 47% FL 1,407,434 1,296,661 92% 1,046,493 74% GA 400,469 358,239 89% 284,246 71% HI 16,502 13,728 83% 9,937 60% IA 44,901 38,952 87% 23,655 53% ID 84,737 74,808 88% 56,680 67% IL 295,176 241,296 82% 142,949 48% IN 144,459 106,407 74% 68,001 47% KS 85,227 73,661 86% 47,904 56% KY 72,588 56,276 78% 36,578 50% LA 109,877 98,729 90% 62,168 57% MA 236,177 174,818 74% 147,513 62% MD 133,317 101,577 76% 76,151 57% ME 69,992 60,776 87% 37,649 54% MI 274,887 227,209 83% 135,556 49% MN 86,108 63,505 74% 11,061 13% MO 211,238 185,343 88% 120,354 57% MS 65,475 61,076 93% 52,334 80% MT 45,848 39,863 87% 19,634 43% NC 455,412 426,575 94% 306,309 67% ND 19,940 16,883 85% 9,298 47% NE 73,855 68,862 93% 41,268 56% NH 46,341 29,410 63% 16,668 36% NJ 243,760 193,240 79% 126,694 52% NM 44,271 32,376 73% 20,981 47% NV 74,993 63,377 85% 42,207 56% NY 211,504 117,945 56% 33,400 16% OH 202,747 153,276 76% 91,881 45% OK 120,985 112,466 93% 76,910 64% OR 133,363 100,132 75% 52,601 39% PA 359,673 300,481 84% 204,950 57% RI 29,374 22,989 78% 16,268 55% SC 181,600 165,456 91% 131,622 72% SD 26,560 24,409 92% 15,764 59% TN 197,360 174,163 88% 117,543 60% TX 942,891 819,321 87% 607,779 64% UT 172,022 149,490 87% 105,610 61% VA 354,344 293,980 83% 213,621 60% VT 28,538 22,354 78% 11,770 41% WA 182,596 113,808 62% 71,812 39% WI 211,025 173,959 82% 107,942 51% WV 27,160 24,012 88% 14,135 52% WY 21,922 19,989 91% 12,205 56% Source: September 15, 2017 CMS Average APTC per month is the total amount of APTC for the month for all consumers who received APTC divided by the number of consumers who received APTC, by state and total.  Average Advanced Premium Tax Credit by State, 2017 (For individuals receiving APTC) State Average APTC per Month Total $373.37 AK $965.53 AL $518.58 AR $274.95 AZ $541.26 CA $348.44 CO $380.79 CT $439.98 DC $252.70 DE $421.20 FL $365.31 GA $359.94 HI $356.86 IA $425.13 ID $352.10 IL $369.17 IN $263.35 KS $378.32 KY $292.95 LA $437.21 MA $177.05 MD $316.72 ME $414.11 MI $265.91 MN $431.95 MO $400.54 MS $382.03 MT $480.91 NC $593.70 ND $288.14 NE $509.97 NH $250.42 NJ $350.75 NM $285.78 NV $288.85 NY $232.46 OH $268.25 OK $553.58 OR $347.36 PA $426.82 RI $246.44 SC $422.52 SD $444.19 TN $535.05 TX $335.40 UT $234.08 VA $318.58 VT $323.96 WA $252.92 WI $402.91 WV $565.94 WY $505.45 Source: September 15th, 2017 CMS ### Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.