In recent weeks, the Centers for Medicare & Medicaid Services (CMS) has been incredibly active in releasing a slew of updates that aim to extend health coverage, improve maternal health, and combat fraudulent activities. Here’s a quick rundown of the most noteworthy updates and their broader implications.
On Aug. 11, CMS launched a call to action for all federal and state agencies working with children and families. The objective is to make sure that as many people as possible renew their Medicaid coverage. This all-hands-on-deck approach allows health plans, providers, and community organizations to utilize shared resources to keep children and families insured, especially as states return to standard Medicaid renewal procedures.
The same day, CMS approved Vermont’s extension of postpartum Medicaid coverage for up to a year. Made possible by the American Rescue Plan, this marks a significant milestone for maternal health. Now, 36 states, including the District of Columbia and the U.S. Virgin Islands, have expanded postpartum Medicaid coverage, aiming to combat the maternal health crisis in the U.S.
CMS’s Early 2023 Snapshot Report shows that 15.7 million people have effectuated their Affordable Care Act (ACA) Marketplace enrollments for February 2023, a 13-percent increase from the previous year. This surge is partly due to the American Rescue Plan (ARP) and the Inflation Reduction Act (IRA), which have made health insurance more affordable for millions.
Aug. 14 saw the release of the Request for Applications for the Making Care Primary (MCP) Model. Set to launch in July 2024, this voluntary primary care model will be tested in eight states and aims to improve care management, form partnerships with specialists, and address patients’ social needs like housing and nutrition.
CMS extended the mandatory spousal impoverishment provisions for home- and community-based services in Medicaid through September 2027. This policy protects a portion of a married couple’s resources, allowing married individuals to maintain their eligibility for necessary long-term care services.
New Jersey received an extension for its State Innovation waiver for an additional five years. Actuarial analysis predicts that this extension will result in premiums being 15.8 percent lower on average for individual health insurance coverage, starting from Plan Year 2024.
Lastly, CMS is stepping up its efforts to identify and weed out fraudulent hospice care providers. As of mid-August, unannounced site visits have been made to over 7,000 hospices to ensure compliance. Nearly 400 are under review for potential administrative action.
Through these various initiatives, CMS hopes to continue to make strides in ensuring that Americans have access to affordable, quality healthcare while keeping integrity and transparency at its core.
There has been a noticeable increase in payer actions regarding readmission denials, often justified as efforts to enhance quality of care and align with Medicare’s
The Centers for Medicare & Medicaid Services (CMS) released in its 2025 Outpatient Prospective Payment System (OPPS) Final Rule a new Conditions of Participation (CoPs)
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