CMS Expands Payment, Coverage Options; Special Enrollment Period Shows Record Number of Enrollees

April 14, 2021 - In an effort to deliver more equitable care, states can now expand Medicaid coverage for women postpartum. And CMS proposes increased payments to skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Meanwhile, the special enrollment period sees record number of enrollees in first month and a half.

Medicaid Expansion Offers Greater Postpartum Coverage

HHS began offering states the option to extend maternal Medicaid coverage, extending women’s coverage from 60 days after birth to a full year. As part of the American Rescue Plan, Medicaid programs can amend section 1115 demonstrations to increase this coverage. The extension aims to improve coverage for rural and Black maternal healthcare. Illinois was the first state to receive approval for the amendment. The extension comes as Medicaid and Children’s Health Insurance Program (CHIP) enrollment increased more than 10 percent in October 2020. READ MORE

CMS Increases SNF, Inpatient Rehab Payments

A proposed rule by CMS would increase payments to SNFs by 1.3 percent, or $444 million, during fiscal year 2022. Rates are set to increase beginning October 1, 2021. The proposed rule also makes changes to the Patient Driven Payment Model and SNF Quality Reporting and Value-Based Purchasing Programs. Value-Based Purchasing Program changes would add ten quality measures by 2024 to assess functional status, patient safety, care coordination, and patient experience. Under the proposed rule, SNFs would be subject to more quality reporting through CMS. READ MORE

Another proposed rule would increase payments to IRFs by 1.8 percent or $160 million in fiscal year 2022. The rule also would adjust the outlier threshold to three percent, a 0.3 percent decrease in outlier payments overall, and update the denominator for the Transfer of Health Information to the Patient-Post Acute Care quality measure by removing the location from the definition.

This is one of several proposed changes to quality reporting. CMS also added a measure to track vaccination rates at IRFs among healthcare personnel and monitor the steps being taken in these facilities to reduce transmission and stop the spread of COVID-19. CMS is currently seeking feedback on policy solutions and expanded measure development to also include more robust information on health equity efforts at IRFs. READ MORE

CMS Halts Applications for Global and Professional Direct Contracting Model

On April 12, CMS announced it would no longer be accepting applications for the Global and Professional Direct Contracting Model set to launch on January 1, 2022. Those organizations that deferred the start date will still be able to participate in the model, provided they meet the contracting requirements by the launch date. Organizations that did not defer will continue to move forward with the model as planned.

In total, 53 organizations have been selected to participate in two models: the Professional option assumes 50 percent shared savings and losses while the Global option offers 100 percent financial risk. The payouts are tied to the number of Medicare fee-for-service and dual eligible beneficiaries attributed to a provider in both models. READ MORE

Special Enrollment Period Sees 500,000 New Enrollees

More than half a million new enrollees have obtained health insurance through the Federal Marketplace under the Special Enrollment Period laid out in the American Rescue Plan. Many of the individuals enrolled come from states that are resisting Medicaid expansion, including Florida (146,250 enrollees), Texas (98,082 enrollees), and Georgia (40,098 enrollees). It is only a month and a half since Special Enrollment Period began and the final deadline to enroll is August 15. READ MORE

J&J Vaccine Rollout Paused by CDC, FDA

After the emergence of six rare and severe blood clots in women who received the Johnson & Johnson (Janssen) COVID-19 vaccine, the CDC and FDA have paused the vaccine’s rollout. Over 6.8 million doses have already been distributed throughout the country, so pausing the trial shows an abundance of caution from regulators. The CDC’s Advisory Committee on Immunization Practices will be meeting today to investigate further and the FDA plans to do the same. READ MORE