South Dakota expands Medicaid coverage: 4 CMS updates

From the expansion of South Dakota's Medicaid program to updated COVID-19 vaccination and education guidelines for long-term care facilities, here are four key CMS developments from the past two weeks: 

1. CMS approved a state plan amendment permitting South Dakota to expand Medicaid coverage to adults with incomes up to 133 percent of the federal poverty level beginning July 1. Under the Affordable Care Act, states have the ability to expand Medicaid coverage. With the addition of South Dakota, 39 states and the District of Columbia have done so.

2. The agency released the fifth evaluation report of the Oncology Care Model, designed to provide higher quality and more coordinated oncology care at the same or lower cost to Medicare. According to the report, the OCM led to reductions in total episode payments, primarily through improved use of high-value supportive care drugs among higher-risk cancer types. The reductions were offset by increased performance-based payments and monthly enhanced oncology service payments, such that net losses decreased over time but did not result in net savings.

3. CMS released the fifth evaluation report of the Comprehensive Care for Joint Replacement Model, launched in 2016 to determine whether an episode-based payment model for lower extremity joint replacement can lower payments while maintaining or improving quality. Hospitals participating in the model achieved a statistically significant reduction in average episode payments due to reductions in institutional post-acute care use, according to the report. Quality of care — measured by the unplanned readmission rate, emergency department use, mortality and the elective lower extremity joint replacement complication rate —- improved or was maintained under the model. 

4. Following the end of the COVID-19 public health emergency, CMS issued a final rule that sunsets federal requirements for healthcare workers to be vaccinated. The agency will continue to require skilled nursing, long-term care and intermediate care facilities for individuals with intellectual disabilities to provide COVID-19 educational information and vaccines to their residents, clients and staff. CMS said it will continue encouraging everyone to stay current on their vaccines.


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