CMS Roundup

The Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.

CMS Highlights Initiative for a Quicker Path to Medicare Coverage of Break Through FDA-Approved Medical Devices for Patients with Life-Threatening Diseases and Conditions

August 25: CMS published an article in the Journal of the American Medical Association (JAMA) summarizing the Transitional Coverage of Emerging Technologies (TCET) pathway program, which uses national coverage determination (NCD), and coverage with evidence development (CED) processes, to expedite Medicare coverage of certain Food and Drug Administration-approved technologies to treat life-threatening or irreversible debilitating medical conditions. The TCET approach was announced in June when CMS issued a proposed procedural notice and guidance documents as part of the agency’s ongoing commitment to fostering innovation, while ensuring that people with Medicare have faster and more consistent access to technologies that will improve health outcomes.

CMS Announces Navigator Non-Compete Continuation Awards to Help Uninsured Consumers Find Affordable, Comprehensive Health Coverage

August 25: HHS/CMS announced it is investing $98.6 million in grant funding in 57 returning Navigator organizations for the 2024 Open Enrollment Period, to help consumers establish eligibility and enroll in coverage through the Marketplace, Medicaid, or the Children’s Health Insurance Program (CHIP). These awards will enable Navigator organizations to retain staff and add to the more than 2,300 existing Navigators who have been trained to help consumers find affordable, comprehensive health coverage. This follows a historic Open Enrollment Period in 2023 and is part of the Biden-Harris Administration’s efforts to help connect people to coverage.

CMS Issues Regulations Requiring State Medicaid and Children’s Health Insurance Programs (CHIP) for the First Time to Annually Report on Measures of the Quality of Health Care Provided to Beneficiaries

August 28: Medicaid and the Children’s Health Insurance Programs (CHIP) play a significant role in America’s health care system and, for the first time, states, the District of Columbia (DC), and certain territories are required to mandatorily report quality measures for health care provided to millions of people nationwide. CMS will use the data to assess access and quality of care furnished by state Medicaid and CHIP programs as part of its ongoing efforts to advance health equity for low-income adults, children, and people with disabilities.

CMS Approves West Virginia Mobile Crisis State Plan Amendment Providing Rapid Response to Mental Health and Substance Use Medicaid Recipients in Crisis

September 5: CMS approved the eighth mobile crisis state plan amendment (SPA) — West Virginia — to support community-based mobile crisis intervention services for individuals with Medicaid. President Biden signed this new option into law through the American Rescue Plan (ARP) to provide essential tools to meet people in crisis where they are, and rapidly provide critical services to people experiencing mental health or substance use crises by connecting them to a behavioral health specialist 24 hours per day, 365 days a year. This option helps states integrate these services into their Medicaid programs, a critical component in establishing a sustainable and public health-focused support network.

CMS Approves Added Benefits to Essential Health Benefits (EHB) Benchmark Plans in North Dakota and Virginia

September 6: CMS approved added benefits to the Essential Health Benefits (EHB) benchmark plans for North Dakota and Virginia for the 2025 plan year. The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in ten benefit categories. For plan year 2020 and after, the Final 2019 HHS Notice of Benefits and Payment Parameters provides states with greater flexibility by establishing new standards for states to update their EHB-benchmark plans, and for tailoring them to fit the health care needs of their states.

CMS.gov Redesign Improves Public Facing Website for Easier Access to Agency Information

September 6: CMS improved the look and feel of its public-facing website CMS.gov. The agency embarked on an information architecture (IA) redesign that focuses on organizing, structuring, and labeling content on CMS.gov in an effective way to help people more efficiently find information and complete tasks. CMS.gov is the online public face of the Agency and the authoritative source of information for Medicare, Medicaid and CHIP, and Marketplace. Through the redesign, CMS continues to deliver clear, accurate, and transparent information to the public, while making it more user-friendly and easier to navigate.

CMS Issues Fact Sheet on the Process for the Medicare Drug Price Negotiation Program

September 8: CMS issued a fact sheet with key information on the process for the first round of negotiations for the Medicare Drug Pricing Negotiation Program, following the Historic Announcement of the First Selected Drugs for Medicare Drug Price Negotiation.