CMS Forwards Its Health Equity Agenda through Its Annual Prospective Payment System Rulemaking Process
Tuesday, May 2, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is using its annual rulemaking process to update the CMS payment system rules for fiscal year (“FY”) 2024 as a mechanism to advance health equity systematically across various CMS payment programs. Specifically, CMS is incorporating proposals to advance health equity in its proposed payment rules for inpatient hospitals and long-term care hospitals, skilled nursing facilities, inpatient psychiatric facilities, and hospices, and in the final rate announcement for the Medicare Part C and Part D programs for FY 2024. Significantly, in several instances, CMS is requesting comments, which opens the door for providers to share their input about relevant considerations. This CMS initiative is consistent with key components that were detailed in CMS’s “Framework for Health Equity,” the agency’s 10-year plan to “remedy systemic barriers to equity so that every one [CMS] serve[s] has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”[1] This post outlines the changes being proposed by CMS, as well as highlights opportunities where providers should consider preparing and submitting comments.

The Proposed Changes

In addition to incorporating the typical updates that structure how CMS reimburses providers and facilities for services furnished to Medicare beneficiaries, as summarized below, the FY 2024 rules contain significant changes that, if implemented, would serve to promote health equity in each of the Medicare program’s products and service lines. Providers are encouraged to submit comments in response to the various categories described below, and EBG is available and equipped to assist in the preparation of any such submissions.

(1) Inpatient Hospital and Long-Term Care Hospital Proposed Rule[2]

(2) Skilled Nursing Facility Proposed Rule[4]

(3) Inpatient Psychiatric Facility Proposed Rule[5]

(5) Medicare Advantage and Part D Rate Announcement[7]

Looking Forward

The proposed changes reflect CMS’s strategic priority to “advance health equity by addressing the health disparities that underlie [the U.S.] health system.”[9] The proposed changes are consistent with CMS’s commitment to leveraging quality improvement in an effort to ensure all individuals have access to equitable care and coverage. Similarly, the proposed changes reflect CMS’s determination to ensure that health equity be embedded “in every aspect of CMS Innovation Center models,” including the increased flexibility for Medicare Advantage plans to offer supplemental benefits to the chronically ill, and recent national coverage determination proposals that would expand certain aspects of beneficiary coverage.

If finalized for implementation in FY 2024, the proposed changes would allow CMS to use the near-term payment years to implement reporting requirements that will facilitate continued growth of CMS’s baseline knowledge about existing healthcare disparities and healthcare social needs among the Medicare population. Such increased knowledge and access to data will better enable CMS to implement various incentive programs structured to fund and reward providers and facilities for delivering care in a way that prioritizes health equity.


FOOTNOTES

[1] https://www.cms.gov/files/document/cms-framework-health-equity-2022.pdf at 4.

[2] https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-improve-patient-safety-and-promote-health-equity

[3] https://www.cbo.gov/system/files/2022-05/51302-2022-05-medicare.pdf

[4] https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2024-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1779-p

[5] https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2024-medicare-inpatient-psychiatric-facility-prospective-payment-system-ipf-pps-and

[6] https://www.cbo.gov/system/files/2022-05/51302-2022-05-medicare.pdf

[7] https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f

[8] https://www.cbo.gov/system/files/2022-05/51302-2022-05-medicare.pdf

[9] https://www.cms.gov/files/document/strategic-plan-overview-fact-sheet.pdf

 

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