Start of 2023 indicates agenda for year, CMS leaders say

Actions so far in 2023 will lead to more program changes for beneficiaries, physicians, and health care across the nation, according to leaders of the U.S. Centers for Medicare & Medicaid Services (CMS).

On April 25, 2023, CMS leaders held a national online meeting to update stakeholders on activities from the first quarter of 2023.

“Working alongside all of you, our amazing partners, we've made great strides to advance health equity, expand access, engage our partners, drive innovation, protect our programs, and foster operational excellence,” said CMS Administrator Chiquita Brooks-LaSure. Among the highlights:

COVID-19 PHE

CMS has published updated fact sheets on changes coming with the end of the COVID-19 public health emergency (PHE). CMS clearly delineates which flexibilities expire at the end of the PHE and what will be extended through the legislative changes enacted by Congress, said Lee Fleisher, MD, chief medical officer and director of the CMS Center for Clinical Standards and Quality. For example, telehealth flexibilities enacted since the onset of the pandemic will be extended.

“CMS has always been committed to watching the data and pivoting as necessary,” he said.

Health insurance

In March CMS announced almost 16.4 million people were enrolled or re-enrolled in health insurance plans through HealthCare.gov Marketplaces or state-based marketplaces. Enrollment increased by 1.8 million people from 2022, and up by 4.4 million since 2021.

With the end of the COVID-19 PHE, CMS is working with states to transition back to regular Medicaid eligibility operations, Brooks-LaSure said. That unwinding process has led to a new HealthCare.gov open enrollment period for people losing health insurance benefits through Medicaid or the Children’s Health Insurance Program (CHIP).

“It's one of our top priorities to ensure that people know the steps they need to take to maintain coverage or where to turn next if they are no longer eligible for Medicaid and CHIP,” Brooks-LaSure said. She asked those attending to spread the word to as many people as possible.

Drug price negotiation

In September, CMS will publish the first 10 Medicare Part D drugs selected for the first round of price negotiations for costs starting in 2026. That ability comes through the Medicare Drug Price Negotiation Program in the federal Inflation Reduction Act, approved last year.

Douglas Jacobs, MD, MPH, Medicare chief transformation officer, discussed the drug price talks with other rule changes coming for Medicare, including quicker prior authorizations, more access to behavioral health, quality care for underserved populations, and accurate payments.

“As with all final rules, the next step is how these provisions get implemented on the ground,” Jacobs said. “It will be important for us to hear how it's going and what we're learning. This will help us make refinements over time to continue to strengthen the program.”

Universal Foundation

CMS leaders have proposed a new Universal Foundation of quality performance across its health care programs, Fleisher said.

“This initiative prioritizes outcomes that are meaningful (for) patients, reduces burden and duplication for clinicians, facilities and health insurers, while moving towards a building block approach that will align CMS quality programs,” Fleisher said. “This universal foundation of quality measures will apply to as many CMS quality rating and value based care programs as possible, with additional measures added on depending on the population or setting.”

The measures include equity as a domain for review and screening for social drivers of health, according to the New England Journal of Medicine article announcing them.

Earlier this year, Physicians Foundation President Gary Price, MD, MBA, suggested that measure could serve as a base for physicians to address social drivers of health for their patients. Some physicians had “mixed reactions” to the Universal Foundation criteria, according to another article published by the American Academy of Family Physicians.