CMS Proposes Updates to Reduce Barriers to Coverage, Simplify Medicare Enrollment and Expand Access

Proposed rule would create Special Enrollment Periods, reduce gaps in Medicare coverage and improve administration of the Medicare Savings Programs.

[The] Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. This proposed rule would provide Medicare coverage the month immediately after enrollment, thereby reducing the uninsured period and expand access through Medicare special enrollment periods (SEPs). It would also allow eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty. This proposed rule would make it easier for people to enroll in Medicare and eliminate delays in coverage.

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Most Want to 'Age in Place' at Home, But Many Aren't Prepared

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, April 13, 2022 (HealthDay News) -- The vast majority of aging Americans want to stay in their homes and live independently for as long as possible, but many haven't considered what needs to be done to achieve "aging in place," a new poll reveals.

Nearly 9 in 10 Americans (88%) between 50 and 80 years of age said it's important to remain in their homes as they grow older, the latest University of Michigan National Poll on Healthy Aging found.

But nearly half (47%) admitted they'd given little or no thought to the steps they'd need to take so they could remain safely and comfortably at home in their old age.

"So many older adults want to be able to stay at home for as long as possible, but it just doesn't seem as though most are really thoughtful about what that means and the sorts of ways in which they have to prepare," said Sheria Robinson-Lane, an assistant professor with the University of Michigan School of Nursing, and co-author of a report on the poll findings.

The AARP-sponsored poll found that only 1 in 3 middle-aged and older folks (34%) said their home has the necessary features that would allow them to age in place. Another 47% said it probably does, and 19% said it does not.

Common accessibility features people reported in their homes were a ground-floor bathroom (88%) and bedroom (78%). But after that, few people appeared to have homes outfitted for easy and safe aging. Only about half (54%) had door frames wide enough for a wheelchair; 32% had lever-style door handles, and 19% had home entrances with ramps or no stairs. About 36% of bathrooms had shower chairs or benches or raised-height toilet seats; 32% had grab bars, and just 7% had barrier-free showers.

Proposed Payment Rules for Other Settings Forecast Home Health Trouble

Home Health Care News | By Joyce Famakinwa
 
Home health operators are still several weeks away from getting a glimpse at the proposed payment rule for 2023. Even so, they’re beginning to see signs of concern that they’ll not be getting an inflation-adjusted rate.
 
Because of workforce investments, more expensive supplies and the overall cost increase of goods and services in the U.S., including the price of gasoline, it has gotten more expensive for home health agencies to stay in business.
 
As a result, the U.S. Centers for Medicare & Medicaid Services (CMS) should factor that into its annual rate update, advocates say.
 
“Rising gas prices are an issue for home health and hospice providers, and expenses around workforce, supplies, and other goods and services cut across home health providers as well as hospice, nursing homes and other service settings,” Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told Home Health Care News in an email. “LeadingAge’s nonprofit and mission-driven home health members tell us they’re concerned about the rising cost of gas and staffing – and they would love to see these price increases recognized in the annual update.”
 
Gurian is not alone in feeling that way.
 
While CMS does update the home health rates by an inflation index every year, the updates have failed to keep pace with the rising costs for staffing, medical supplies and fuel, Joanne E. Cunningham, executive director of the Partnership for Quality Home Healthcare, told HHCN.

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Federal Independent Dispute Resolution (IDR) Portal Launched

April 15, 2022, the Centers for Medicare & Medicaid Services opened the Federal Independent Dispute Resolution (IDR) process for providers (including air ambulance providers), facilities, and health plans and issuers to resolve payment disputes for certain out-of-network charges.

To start a dispute, an initiating party will need:

• · Information to identify the qualified IDR items or services;  
• · Dates and location of items or services;
• · Type of items or services such as emergency services and post-stabilization services; 
• · Codes for corresponding service and place-of-service;  
• · Attestation that items or services are within the scope of the Federal IDR process; and
• · The initiating party’s preferred certified IDR entity. A list of certified entities can be found here. 

At the end of the 30-business-day open negotiation period, initiating parties have 4 business days to initiate a dispute via the portal. As a result of the recent decision in Texas Medical Ass’n, et al. v HHS, the Departments will give disputing parties whose open negotiation period expired before today, April 15, 2022, 15 business days to file an initiation notice via the IDR Portal.

Even after starting the Federal IDR process, disputing parties can continue to negotiate until the IDR entity makes a determination. If the parties reach an agreement on the out-of-network payment rate, they should email the certified IDR entity and the Departments (at [email protected]).

If the disputing parties experience extenuating circumstances during the IDR process that prohibit them from complying with deadlines to submit information, they may email the Departments (at [email protected]) to receive a Request for Extension Due to Extenuating Circumstances form and instructions for next steps.

To learn more about the independent dispute resolution process, including to read guidance materials, FAQs, and model notices, visit www.cms.gov/nosurprises