News

CMS Approves Coverage of Traditional Healthcare Practices in 1115 Waivers

• On October 16, CMS approved several 1115 demonstration amendments which authorize Medicaid coverage of traditional healthcare practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations. Arizona, California, New Mexico, and Oregon now have approval to support these facilities and organizations to provide holistic, culturally appropriate patient care. According to IHS Director Roselyn Tso, IHS is the 17^th largest healthcare system in the country. American Indians and Alaska Natives often experience poor healthcare outcomes for physical and mental health compared to other populations. Studies support the use of traditional healthcare practices to improve health outcomes for conditions like diabetes, cancer, mental health and substance use disorders (CMS, October 16).

Biden Administration Proposes Rule to Expand Contraceptive Coverage

• On October 21, the Biden-Harris Administration proposed a rule that would expand coverage of contraception under the Affordable Care Act (ACA). The proposed rule requires payers to provide no-cost coverage of over-the-counter birth control, emergency contraception, and spermicides. Additionally, private plans will be required to cover these medications unless they currently cover a non-cost sharing therapeutic equivalent. The proposed rule has the potential to increase contraceptive coverage for approximately 52 million women of reproductive age who are on private health insurance. The proposed rule builds on the administration’s previous actions to bolster access to contraception and related services, including growing family planning service within Title X clinics, supporting the coverage of family planning services through Medicaid and Medicare, promoting research and data analysis to tackle access gaps and disparities, and increasing contraception access for federal employees and their families, college students, service members and veterans, and within federal health centers (White House, October 21; Health Payer Specialist, October 21).

Federal Legislation

Bipartisan Group of House Lawmakers Seeks Medicare Reforms in Lame Duck Package

• A bipartisan majority of House lawmakers is seeking to protect physicians from the anticipated 2.8% Medicare pay cut in 2025. Two hundred and thirty-three House lawmakers signed a letter requesting that leadership prevent the 2.8% reduction to payment rates in the expected lame duck package and consider enacting other Medicare reforms that have been brought to Congress. The letter details that Medicare payments have fallen by nearly 30% over the last twenty years, negatively impacting practices, especially in rural and underserved areas. The House lawmakers also addressed other policy reforms in the letter such as tying payment updates to reflect inflationary changes and revising the Medicare physician fee schedule budget neutrality requirements to prevent additional cuts. Additionally, the letter referenced the Merit-based Incentive Payment System and the potential to improve quality measures and bonus payments. Lobbyists anticipate that Congress will mitigate immediate Medicare cuts but that broader reforms will be postponed until the next session (Inside Health Policy, October 17).

Federal Studies and Reports

ASPE Final Report Sheds Light on Medicaid Nursing Facility Payments and Cost Coverage

• On October 11, the Office of the Assistant Secretary for Planning and Evaluations (ASPE) released a final report that studies the relationship between nursing home Medicaid reimbursement rates and the cost of care for the facilities. The survey, which included 13,285 nursing homes, had these key findings: Most nursing homes (52%), had 80 to 100% of their Medicaid per diem costs covered; 40% of nursing homes had 80% or less of estimated Medicaid costs covered; and 8% had Medicaid payments exceeding their per diem costs. Additionally, not-for-profit nursing homes reported the lowest Medicaid payment-to-cost ratio compared to that of for-profits and government owned facilities. On average, Medicaid reimbursement covers 82 cents on the dollar of all reported nursing facility costs. The study also reviewed staffing levels within nursing facilities and found facilities that saw nursing staff levels of 4.0 per resident per day had the lowest Medicaid payment-to-cost ratio at .77, while homes with nursing staff levels below 3.0 per resident per day had the highest Medicaid payment-to-cost ratio of 8.5 (ASPE, October 11; McKnights Long-Term Care News, October 16; Skilled Nursing News, October 18).