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July/August 2022 Industry Updates
HHS Grants States Additional Year to Use American Rescue Plan Funds for Medicaid Services
The US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced an extended deadline for states to use federal funding to improve home- and community-based services for Medicaid beneficiaries.
According to a press release by HHS, states will now be able to use funding from the American Rescue Plan through March 31, 2025, instead of March 31, 2024. The additional year is intended to support the expansion of long-term services, which could reduce costs and allow beneficiaries to receive care in settings of their choice, rather than being limited to services from institutions.
“These additional funds will help people with Medicaid to live and thrive in the setting of their choice,” said CMS Administrator Chiquita Brooks-LaSure. “With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities.”
The American Rescue Plan has temporarily boosted funding for Medicaid to expand home- and community-based service, providing states with an additional $12.7 billion, according to the press release.
States are permitted to use the funding to address workforce and structural problems in home- and community-based services; expand services to reduce caregiver burden and provide access to individuals on waitlists; and emphasize person-centered care with personalized activities.
The funds have been used to improve pay and benefits for direct service workers, as well as support beneficiaries at high risk for contracting COVID-19 while simultaneously reducing costs by providing services at home rather than in nursing homes and other long-term care facilities.
“We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce,” said HHS Secretary Xavier
Becerra. —Maria Asimopoulos
Medicare Beneficiaries in Disadvantaged Areas Used Telemedicine More During Pandemic
People living in the most disadvantaged neighborhoods in the United States had greater odds of using telemedicine than those living in the least disadvantaged neighborhoods after the Centers for Medicare & Medicaid Services (CMS) expanded coverage to all Medicare beneficiaries in 2020, findings showed.
“Telemedicine is one means by which access to health care may be improved. The utility of telemedicine has become particularly evident during the COVID-19 pandemic, as remote consulting and triaging allow patients to maintain adequate physical distancing and avoid overburdening hospitals.”
CMS expanded telemedicine coverage to all Medicare beneficiaries on March 6, 2020. The retrospective cohort study was conducted using Medicare fee-for-service claims data for adult patients who had at least 1 outpatient visit from January 2019 through March 2021.
Before coverage was expanded, .42% of patients had at least 1 telemedicine visit (129,114 out of 30,488,891 total patients). By contrast, 9.97% of patients had at least 1 telemedicine appointment after the expansion (2,795,242 out of 28,038,684 total patients, P < .001).
Researchers used the area deprivation index (ADI) to determine the socioeconomic status of patients. The ADI includes “household income, education, employment, and housing quality at the census block group level to provide a more holistic assessment of geographical socioeconomic disadvantage than individual socioeconomic status markers can provide,” authors noted.
In the week following the coverage expansion, telemedicine use increased 56-fold in the least disadvantaged neighborhoods (95% CI: 12.3, 253.7,
P < .001) vs 28.9-fold in the most disadvantaged neighborhoods (95% CI: 10.4, 79.9, P < .001).
While studying the association between patient characteristics and telemedicine use, researchers adjusted for demographic variables, comorbidities, and region and residency factors.
Before the waiver was implemented, people living in the most and least disadvantaged areas had similar odds of using telemedicine (ADI-4 vs ADI-1, OR: .97; 95% CI: .94, 1.01). Increasing age and Black race were linked to lower odds of utilization, and higher odds were associated with female sex, increasing Charlson Comorbidity index score, and rural location.
By contrast, after the waiver was implemented, “increasing ADI quartile was persistently associated with higher odds of telemedicine use,” researchers said. People living in the most disadvantaged areas had the highest odds of using telemedicine, compared to those living in the least disadvantaged neighborhoods (ADI-4 vs ADI-1, OR: 1.14; 95% CI: 1.12, 1.15).
Odds of using telemedicine were lower with increasing age and rural location in the postwaiver period. Higher odds were associated with female sex, Asian and Hispanic race and ethnicity, and increasing Charlson Comorbidity Index score.
“Overall, our data suggest large swings in access to telemedicine across the United States for all populations, including people living in the most disadvantaged neighborhoods,” authors said.
“The correlation shown by our data suggests that CMS was, in fact, successful in reaching even people in the most disadvantaged US neighborhoods with its telemedicine coverage waiver, at least among Medicare
beneficiaries.” —Maria Asimopoulos
HHS Approves Postpartum Medicaid, CHIP Coverage Expansion in 4 States
Through the Centers for Medicare & Medicaid Services (CMS), the US Department of Health and Human Services (HHS) granted California, Florida, Kentucky, and Oregon approval to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage 12 months postpartum, improving access for more than 126,000 families.
“The first year after giving birth is a critical period—and families deserve the peace of mind knowing they will be able to access the health care coverage they need, without interruption,” said HHS Secretary Xavier Becerra.
California, Kentucky, and Oregon’s approved expansions were made possible under the American Rescue Plan, whereas Florida’s coverage is made available through a Medicaid and CHIP section 1115 demonstration.
“The American Rescue Plan gives all states an easier pathway to extend postpartum coverage beyond the critical first weeks for a new family, which can put all our communities—particularly those hard hit by health disparities—on a better course toward health and well-being,” said CMS Administrator Chiquita Brooks-LaSure.
According to data published by the HHS Office of Assistant Secretary for Planning and Evaluation (ASPE), “1 in 3 pregnancy-related deaths occur between one week and one year after childbirth.”
These most recent expansions follow South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey, and Illinois which already extended coverage from 60 days to 12 months postpartum for Medicaid and CHIP. Several states, including Indiana, Maine, Minnesota, New Mexico, Pennsylvania, West Virginia, North Carolina, Washington, and Connecticut, as well as the District of Columbia are actively working with CMS to follow suit.
“As a result of these efforts, as many as 720,000 pregnant and postpartum individuals across the United States, annually, could be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy,” stated CMS in a press
release. —Edan Stanley
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