In this Policy Round-Up:
- Response from the Census Bureau regarding proposed changes to disability questions.
Input needed:- CMS issues draft guidance on new program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly payments. (Comments due 3/16.)
Revised CMS lower limb prosthetic coverage determination. (Comments due this Saturday, 3/2.) - CMS seeks feedback on Medicare Advantage transparency, data. (Comments due 5/29.)
- FEMA reforms to help improve disaster assistance program. (Comments due 7/22.)
- CMS issues draft guidance on new program to allow people with Medicare to pay out-of-pocket prescription drug costs in monthly payments. (Comments due 3/16.)
- Final rule issued on classifying employees and independent contractors under the FLSA.
- IRS raises ABLE account limits.
- Important “double deadline” for people eligible for Medicare, Medicare Advantage enrollees.
- HHS launches new resource hub on Medicaid and CHIP renewal transition for national, local partners.
- HHS releases data strategy.
Response From the Census Bureau Regarding Proposed Changes to Disability Questions
As we’ve discussed previously, the Census Bureau had proposed changes to disability questions posed in the American Community Survey (ACS) and Puerto Rico Community Survey (PRCS) beginning in 2025. The ACS and PRCS are annual surveys conducted by the Census Bureau to provide current data on demographics and population changes happening around the country.
Based on public feedback to that proposal, the Census Bureau recently announced that it would retain the current disability questions for its 2025 survey.
Comments on the proposed changes had raised concerns about the impact of the changes on disability data and, potentially, funding and services. The Bureau will continue to work with stakeholders and the public to determine what revisions, if any, are necessary.
The Bureau will also convene a meeting this spring with a variety of stakeholders, including disability community representatives, data users, researchers, and disability advocates to discuss disability data needs and uses.
Input Needed: CMS Issues Draft Guidance on New Program To Allow People With Medicare To Pay Prescription Drug Costs in Monthly Payments
The Centers for Medicare & Medicaid Services (CMS) is seeking input on the second part of its draft guidance on the Medicare Prescription Payment Plan. Starting in 2025, the plan gives people with Medicare Part D prescription drug coverage the option to pay their out-of-pocket costs in monthly payments spread out over the year.
This draft guidance builds on part one of the draft guidance and a fact sheet released in August. While part one focused on operational requirements, part two focuses on outreach, education, and communications requirements to ensure that people with Medicare Part D are aware of the Medicare Prescription Payment Plan. The draft includes:
- Outreach and education requirements for Part D plan sponsors, including requirements for member ID card mailings, updates to current Part D materials, and website content.
- Requirements for communications between Part D plan sponsors and prospective and current program participants, particularly around the topics of payment plan election and voluntary removal, non-payment, and termination.
- Information on CMS’ planned outreach and education activities, which include developing an educational product on the program, modifying existing Part D enrollee resources to include information on the program, and engaging interested parties through national outreach and education efforts.
- Additional operational requirements for Part D plan sponsors, including guidance for non-retail pharmacies, Part D bidding for contract year 2025, and Medical Loss Ratio (MLR) instructions.
Comments can be submitted until March 16. Please send comments to PartDPaymentPolicy@cms.hhs.gov with the subject line ““Medicare Prescription Payment Plan Guidance – Part Two.”
For more information on the draft guidance, see this fact sheet.
Input Needed: Revised CMS Lower Limb Prosthetic Coverage Determination
CMS is seeking input on a proposed lower limb prosthetic local coverage determination (LCD) that expands coverage for microprocessor-controlled knees (MPKs) and (attached) prosthetic feet.
Local coverage determinations are decisions made regarding whether a particular service or item is reasonable and necessary, and therefore covered by Medicare. This proposed LCD would expand coverage to allow more people to get MPKs, which have sensors that allow them to adjust to a user’s walking patterns, which in turn allows people to walk with more stability than mechanical prosthetics. It would also modify current coverage to require covered MPKs to include technology that can detect when the user trips or stumbles and automatically adjusts to help prevent falls. The proposed LCD also expands coverage for a prosthetic foot to allow coverage of a MPK-compatible foot for individuals who meets the MPK coverage criteria.
Comments can be submitted by email until March 2.
Input Needed: CMS Seeks Feedback on Medicare Advantage Transparency, Data
CMS is seeking feedback from the public on how best to enhance Medicare Advantage (MA) data capabilities and increase public transparency.
Public feedback will support CMS’ efforts to ensure that MA plans best meet the needs of people with Medicare, people with MA have timely access to care, MA plans appropriately use taxpayer funds, and the MA market has healthy competition. CMS requests comments on all aspects of data related to the MA program.
One of the topics CMS is especially interested in includes data-related recommendations related to:
- Beneficiary access to care, including provider directories and networks.
- Prior authorization and utilization management, including denials of care, beneficiary experience with appeals processes, and use and reliance on algorithms.
- Care quality and outcomes, including value-based care arrangements and health equity.
- Special populations, such as people dually eligible for Medicare and Medicaid, people with end stage renal disease (ESRD), and other enrollees with complex conditions.
Comments can be submitted online or by mail until May 29.
Input Needed: FEMA Reforms To Help Improve Disaster Assistance Program
The Federal Emergency Management Agency (FEMA) published an interim final rule (IFR) that seeks to simplify processes, remove barriers to entry, and increase eligibility for certain types of assistance under their Individual Assistance program. These changes will help make it easier for people to receive the assistance they need after a disaster, which is especially important for people with disabilities and older adults, who are disproportionately affected during and after disasters due to accessibility needs.
Among other things, the interim rule:
- Increases eligibility for home repair assistance.
- This includes allowing survivors with disabilities to use FEMA funding to make certain accessibility improvements to homes damaged by a declared disaster. This change helps survivors with disabilities improve their living conditions by making their homes even more accessible than they were pre-disaster.
- Makes improvements to program registration requirements.
- Simplifies the documentation requirements for continued temporary housing assistance.
- Simplifies the appeals process.
- Establishes additional eligible assistance for serious needs, displacement, disaster-damaged computing devices, and essential tools for self-employed individuals.
The IFR goes into effect on March 22. Comments can be submitted online until July 22. FEMA will then consider whether to make changes to the rule on the basis of comments received.
Final Rule Issued on Classifying Employees and Independent Contractors Under the FLSA
The U.S. Department of Labor (DOL) issued a final rule revising previous guidance on how to determine whether a worker is an employee or independent contractor under the Fair Labor Standards Act (FLSA). The rule will take effect March 11. Determinations about who is an employee or independent contractor can have a big impact on direct care workers, and this revision will help to protect employees’ rights and ensure they benefit from protections under federal labor laws.
The new final rule rescinds the 2021 Independent Contractor Rule and returns to longstanding DOL interpretation that is consistent with caselaw of how to determine whether a worker is an employee or an independent contractor. Under the new rule, DOL’s former guidance on making employee/contractor determinations in shared living programs and self direction will again be in effect.
For more information, including frequently asked questions and a compliance guide for small businesses, visit DOL’s resource page on the final rule.
IRS Raises ABLE Account Limits
The Internal Revenue Service (IRS) has increased the amount people with disabilities can save in ABLE accounts, which allow them to save money without losing government benefits.
For 2024, the federal gift tax exclusion limit for ABLE accounts is $18,000, an increase of $1,000, which is similar to raises seen in previous years. The federal gift tax exclusion is the amount that can be deposited in ABLE accounts in total from family and friends and other sources. However, if the designated beneficiary is working and they or their employer are not making certain retirement plan contributions, they may also contribute up to the federal poverty level for a one-person household, but no more than their total income for the year. For 2024, the federal poverty level for a one-person household is $14,580 in the continental U.S., $18,210 in Alaska, and $16,770 in Hawaii.
The money saved in ABLE accounts can be used to pay for qualifying disability expenses, which are expenses made for the benefit of the designated beneficiary and related to their disability. These include, but are not limited to:
- Education
- Housing
- Transportation
- Employment training and support
- Assistive technology and related services
- Health
- Prevention and wellness
- Financial management and administrative services
- Legal fees
- Expenses for ABLE account oversight and monitoring
- Funeral and burial
- Basic living expenses
Important “Double Deadline” for People Eligible for Medicare, Medicare Advantage Enrollees
The Medicare General Enrollment Period and the Medicare Advantage Open Enrollment Period both end on March 31. The Medicare General Enrollment Period is the only time during the year that people eligible for Medicare who did not enroll during their initial enrollment period and do not qualify for a Special Enrollment Period can enroll in Medicare Part A or Part B. During the Medicare Advantage Open Enrollment Period, people with Medicare Advantage (MA) plans can drop their MA coverage or change from one MA plan to another.
For more information, check out this resource from the National Center on Law and Elder Rights.
You also can contact your local State Health Insurance Assistance Program for one-on-one insurance counseling and assistance with Medicare.
HHS Launches New Resource Hub on Medicaid and CHIP Renewal Transition for National, Local Partners
The U.S. Department of Health and Human Services (HHS) has launched a new online hub for partners to access materials related to Medicaid renewals. The user-friendly hub is a key part of the all-hands-on-deck effort to ensure people with Medicaid or Children’s Health Insurance Program (CHIP) coverage complete their renewals if eligible or get connected to other coverage as appropriate.
The new hub features communications materials and toolkits to meet the needs of the diverse general public, including materials in the below languages:
It also includes population-specific outreach materials to reach a variety of different populations. This includes state-specific materials, materials for people living in rural areas, materials for diverse racial and ethnic communities, and materials for people receiving Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits. Partners also can find language to educate their audiences about potential scams and fraud related to Medicaid renewals.
HHS Releases Data Strategy
HHS recently released its data strategy, which outlines the department’s priorities and initiatives to safely and effectively harness data to enhance the health and well-being of all Americans.
The priorities identified as most critical to advance the safe and effective use of data across HHS are:
- Cultivating data talent.
- Fostering data sharing.
- Integrating administrative data into program operations.
- Enabling whole-person care delivery by connecting human services data.
- Responsibly leveraging artificial intelligence.
The strategy also identifies two high-priority use cases: the Cancer Moonshot, which has a goal of reducing the cancer death rate by 50% within 25 years, and preparedness and incident response.
For each priority and each use case, the data strategy identifies an aspiration for the next five or more years, as well as near-term initiatives that can be accomplished within the next one to two years using existing resources and authorities.