CMS releases the Medicaid Long-Term Services and Supports (LTSS) Annual Expenditures Report for FFY 2019

Today, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid LTSS Annual Expenditures Report for Federal Fiscal Year (FFY) 2019. This report discusses the LTSS rebalancing trends and growth in expenditures for home and community-based services (HCBS) as compared to institutional spending during the time period reviewed.

Some of the highlights from this report show:

  • Total Medicaid LTSS spending continues to increase. Expenditures increased from $129 billion in FY 2018 to $162 billion in FY 2019.
  • The percentage of HCBS expenditures comprising total Medicaid LTSS expenditures has steadily increased over the last three decades, but it has slowed in recent years.
  • The U.S. total surpassed the long-standing benchmark of 50 percent of LTSS expenditures in FY 2013 and has remained higher than 50 percent since then, reaching 58.6 percent in FY 2019.
  • Nursing facilities represented the greatest share of institutional LTSS expenditures, accounting for 80 percent of these expenditures in FY 2019.
  • Section 1915(c) waiver programs represented the majority of HCBS expenditures in FY 2019, accounting for slightly more than 50 percent of these expenditures.
  • The amount spent on managed LTSS (MLTSS) programs increased more than three-fold in the past 20 years, climbing from $6.7 billion in FY 2008 to $47.5 billion in FY 2019.

Please learn more here: https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations/index.html 

 

CMS Releases the Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2017-2018

Today, the Centers for Medicare & Medicaid Services (CMS) released the Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2017-2018. This report provides summary information from annual CMS Form 372 report submissions and focuses on trends in section 1915(c) home and community-based services (HCBS) waiver program participation, service use by HCBS population, and expenditures for 2017-2018. Section 1915(c) HCBS waiver programs comprise an important component of HCBS delivery systems in most states.

Some of the highlights from this report show:

  • Nationally, in 2018, approximately 1.8 million individuals participated in section 1915(c) waiver programs, representing a 4.9 percent increase from the prior year.
  • When normalized for overall U.S. population growth, there were approximately 5.81 section 1915(c) waiver program participants per 1,000 total U.S. residents in 2018.
  • In 2018, average section 1915(c) waiver program expenditures per participant per year were $29,453.

Please learn more here: https://www.medicaid.gov/medicaid/long-term-services-supports/reports-evaluations/index.html

 

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions…

…Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements. 

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For more information, please see these Frequently Asked Questions.

Click Here for additional details on the requirements.

 

Updated Materials Available – Visiting Nursing Homes During Omicron Surge

The Centers for Medicare & Medicaid Services (CMS) has updated [their] Nursing Home Resource Center with two new informational products.

As of January 6, 2022, the Nursing Home Visitation FAQs have been updated to provide additional guidance about visitation during the Omicron surge. CMS has also created an infographic to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. These two new resources are available for nursing home providers, patients, caregivers, and CMS partners to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.

 

Supreme Court Blocks Biden's Covid Requirements for Businesses, Upholds Health Care Workers Mandate

By NBC News By Pete Williams

WASHINGTON — The Supreme Court on Thursday blocked the Biden administration's rule requiring larger businesses to ensure that workers receive the Covid vaccine or wear masks and get tested on a weekly basis.

But the court said a separate mandate requiring vaccinations for an estimated 20 million health care workers can be enforced.

The workplace rule, announced last fall by the Occupational Safety and Health Administration, required companies with 100 or more employees to ensure that their workers either get vaccinated or wear masks and show negative Covid test results at least once a week.

The rule would have covered nearly 80 million American workers, and OSHA estimated it would save over 6,500 lives and prevent 250,000 hospitalizations in the next six months.

"Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly," the court's conservative majority said. "Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category."

In their dissent, the three liberal justices on the court said OSHA was well within its authority and expertise to impose the mandates, unlike the court, which they said was "lacking any knowledge of how to safeguard workplaces, and insulated from responsibility for any damage it causes."

"In the face of a still-raging pandemic, this court tells the agency charged with protecting worker safety that it may not do so in all the workplaces needed," the liberal justices wrote. "As disease and death continue to mount, this court tells the agency that it cannot respond in the most effective way possible. Without legal basis, the court usurps a decision that rightfully belongs to others. It undercuts the capacity of the responsible federal officials, acting well within the scope of their authority, to protect American workers from grave danger."

In a statement released later Thursday, President Joe Biden celebrated the verdict in the health care worker case as one that would "save lives," but said he was "disappointed" that the broader workplace mandate was struck down.

"I am disappointed that the Supreme Court has chosen to block common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law," he said, calling on individual businesses to institute their own vaccination requirements.

"We have to keep working together if we want to save lives, keep people working, and put this pandemic behind us," he added.

The Biden administration's workplace rule, announced in November, was immediately challenged by a group of businesses and Republican states that said the government lacked the power to issue such a sweeping mandate. Lower courts initially blocked the requirement, but a later ruling allowed it to go into effect.

In lifting the earlier stay, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit called the OSHA rule "an important step in curtailing the transmission of a deadly virus that has killed over 800,000 people in the United States, brought our health care system to its knees, and cost hundreds of thousands of workers their jobs."

The National Federation for Independent Businesses called the appeals court ruling "a gut punch to America's small businesses who are struggling to stay in business as they come out of the pandemic."

Karen Harned, executive director of the group's small business legal center, called the Supreme Court ruling a "welcome relief" to businesses struggling to keep afloat during the pandemic. She expressed optimism that with the OSHA rule now halted, the lower courts will proceed to find the regulation illegal.

"As small businesses try to recover after almost two years of significant business disruptions, the last thing they need is a mandate that would cause more business challenges," Harned said.

Health Care Workers Mandate

The Supreme Court on Thursday said a separate regulation that requires vaccinations for health care workers who treat Medicare and Medicaid patients could be enforced. Two federal appeals courts had blocked enforcement in 24 states, but the requirement went into effect in the remaining 26.

States opposed to the requirement said the federal law gave the government the authority to impose general health and safety rules for facilities like hospitals, but did not confer the power to require vaccines. The agency that administers Medicare and Medicaid has never before required vaccinations, they said.

Four conservative justices — Clarence Thomas, Neil Gorsuch, Samuel Alito, and Amy Coney Barrett — disagreed with the majority and said they would have struck down the mandate for health care workers. The two justices who opposed the broad worker mandate but supported the health care worker requirement were Brett Kavanaugh and the chief justice, John Roberts.

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