Medicare and medicaid – Medic Buzz Mon, 21 Nov 2022 15:14:38 +0000 en-US hourly 1 Medicare and medicaid – Medic Buzz 32 32 [Webinar] New Medicaid Opportunities for Funding Health-Related Social Needs: A Conversation with States – Jan. 9, 3:00 p.m. – 4:00 p.m. ET | Manatt, Phelps & Phillips, LLP Mon, 21 Nov 2022 14:04:45 +0000

January 9, 2023

3:00 p.m. – 4:00 p.m. ET

This fall, the Centers for Medicare & Medicaid Services (CMS) approved groundbreaking 1115 waivers for Arizona, Massachusetts, and Oregon, allowing new funding and programmatic flexibilities for the delivery of services that address social needs related to health (HRSN). Through these waivers, CMS both approved new services and set a new framework for how it would view waivers to implement HRSN initiatives in the future.

In a new webinar, Manatt will moderate a panel of state leaders from Arizona, Massachusetts and Oregon, providing key insights into the HRSN approval process and actionable lessons for other states considering their own investments in the HRSN. Click here to register for free. Key topics will include:

  • The evolution of Medicaid funding to respond to HRSN that led to the new CMS framework for HRSN waiver initiatives
  • The similarities and differences in the approaches used by Arizona, Massachusetts and Oregon to structure their HRSN investments
  • Guidance for other States seeking to design HRSN funding and system delivery

Even if you can’t attend our live webinar on December 6, click here to register for free and you’ll receive a link to view the program on demand.


  • Jami Snyder, director of the Arizona Healthcare Cost Containment System (AHCCCS)
  • Amanda Cassel Kraft, Assistant Secretary for MassHealth
  • Lori Coyner, senior Medicaid policy advisor at the Oregon Health Authority
  • Cindy Mann, Associate, Manatt Health

If you would like to receive an audio transcript of this webinar due to accessibility issues, please email us at

Medicare drug price negotiations may become more ambitious. here’s how Thu, 17 Nov 2022 18:37:20 +0000


Next year, for the first time, Medicare will be allowed to begin negotiating prices for certain prescription drugs. The policy is expected to cut personal spending and save the US government nearly $100 billion over a decade. This might prove to be one of the most valuable parts of the Inflation Reduction Act, but it’s not without its flaws. For this effort to succeed as it deserves, it will eventually require both greater ambitions and greater attention to detail.

Most seniors get their prescriptions through Medicare Part D, a benefit provided by private plans that contract with the government. Spending is expected to reach $119 billion next year, which is almost a third of what the United States plans for retail drugs. When designing Part D in the early 2000s, pharmaceutical manufacturers called for a “non-interference clause” to prevent the program from haggling over prices. Without it, they said, innovation would be stifled. Already, some manufacturers are blaming the IRA for blocking or halting drug development plans.

This risk seems exaggerated, to put it politely. Currently, only 10 older branded treatments (chosen based on total spend) are included in negotiations, and the list will only slowly grow. New formulations, medicines that compete with generics or biosimilars and certain treatments for rare diseases will be exempt. The Congressional Budget Office estimates that the law as it stands will prevent only 15 of 1,300 new drugs from coming to market over the next 30 years.

Certainly, the reduction in revenue that manufacturers expect to receive over time from new drugs will probably have an effect on innovation, but that does not justify paying what producers dare to ask. Medicare acts on behalf of taxpayers as well as patients, so a balance must be struck. It makes sense to tread carefully, but if all goes well, new legislation could expand its scope faster than the IRA envisages. Keep in mind that public sector drug buyers in other wealthy countries (not to mention Medicaid and the Department of Veterans Affairs in the United States) take these deals for granted.

Beyond ambition, managing the new approach as well as possible will pose challenges. With billions at stake, manufacturers will deploy all resources to reduce the impact. (Judging by the sector’s stock prices, investors believe they will succeed.) Medicare begins hiring new staff to conduct assessments and negotiations. However, the sums earmarked for this seem too low. Additionally, companies might hope to protect revenue by shifting patients from existing drugs to newer versions with no clear therapeutic benefits – known as product skipping. Medicare will have to detect it and prevent it.

Pips are likely to appear before the policy starts offering lower prices – in 2026 at the earliest. In the meantime, the public support needed to sustain reform should not be taken for granted.

For example, the plan expects Medicare to be guided by its assessment of the treatment’s “maximum fair price” — a judgment, in part, of the drug’s cost-effectiveness. This would raise ethical questions about the value of life and so-called quality-adjusted life years. However, the legislation gives no indication of this process. For the new approach to gain public trust, the methods will need to be clarified, explained and defended. Medical systems in Europe and the UK have developed data-driven approaches, and Medicare would be well advised to build on their experience.

Expected for years, this reform is only a modest beginning. But, given the chance, the new approach can be more beneficial to patients and taxpayers without significantly harming innovation, and pave the way for more. It’s quite a price.

More from Bloomberg Opinion:

• Biogen lands a CEO capable of navigating turbulence: Lisa Jarvis

• If you’ve had Covid, watch out for stroke symptoms: Faye Flam

• How to Solve the Dialysis Spending Crisis: Publishers

The editors are members of the Bloomberg Opinion Editorial Board.

More stories like this are available at

]]> More than 2,400 nursing homes achieve top ratings in the United States Tue, 15 Nov 2022 06:01:00 +0000

By incorporating data on staffing and weekend infection rates for the first time, thousands of nursing homes have risen to the top of the charts in the latest US News and World Report rankings.

The 2022-23 list of “best retirement homes” was released on Tuesday. US News rates more than 15,000 nursing homes on factors including care, safety, infection rates, staffing and health inspections.

Specifically, US News used a variety of data from the Centers for Medicare & Medicaid Services (CMS), including information on consistency of nurse staffing, use of antipsychotics, and success in preventing hospitalizations. and emergency room visits.

Long-term care ratings included whether a nursing home changed ownership and staff on weekends, and short-term ratings included success in preventing falls, serious infections, and ability for a resident to to return to his place.

The metrics monitored are part of CMS’s efforts to improve its five-star quality rating system; the agency began publishing weekend staffing and turnover rates on its Medicare Care Compare site earlier this year.

In July, CMS began evaluating these metrics against other five-star factors, including:

  • Total number of nursing staff hours per resident per day on weekends, including RNs, Licensed Practical Nurses (LPNs), and Certified Practical Nurses (CPNs)
  • Total annual turnover of nursing staff
  • AI revenue in a given year
  • Annual number of administrators who have left the nursing home

The five-star “stool” consists of three legs, including staffing, quality and regulatory measures. Historically, regulatory metrics have been weighted the most by CMS, followed by staffing, then quality.

There were 2,426 nursing homes (16%) across the country that were considered high performers in long-term care, acute care or both, according to US News data. Breaking it down even further, 1,658 nursing homes met the short-term rehabilitation high performance category and 1,103 facilities met the long-term care high performance standards.

Only 335 SNFs were high performers in both categories, according to the data.

California State had the top performing SNFs this year – 206 in the short-term category and 148 in the long-term category.

Florida, Pennsylvania and Texas follow as top performers.

“Choosing the right retirement home based on care needs and comfort is a critical decision for potential residents and their families,” Zach Adams, senior health data engineer at US News, said in a statement. “This year, new data available on weekend staffing and infection rates that led to hospitalizations provides even more insight into how nursing homes rank with respect to the safety of their residents.

Amy Stulick contributed to this report.

COVID-19 Public Health Emergency Extended Through Spring 2023 – InsuranceNewsNet Fri, 11 Nov 2022 21:47:21 +0000

The COVID-19 public health emergency will be extended for another year, as CNBC quoted a Biden administration official as saying on Friday that the emergency would be extended until the spring of 2023.

The Department of Health and Human Services previously extended the public health emergency until January. HHS Secretary Xavier Becerra has promised to give health care providers 60 days notice before lifting the emergency declaration so they can prepare for a return to normal operations.

However, the deadline for giving this 60 day notice was Friday and no notice was sent. In October. Becerra said the decision to end the public health emergency will depend on how the nation fares with COVID-19 over the fall and winter.

The public health emergency has dramatically expanded public health insurance through Medicaid and the Children’s Health Insurance Program. Enrollment in these programs increased 26% during the pandemic to a record high of more than 89 million people in June.

According to an analysis by the Kaiser Family Foundation, an estimated 5.3 to 14.2 million people could lose their Medicaid coverage when the COVID-19 public health emergency ends.

The public health emergency declaration gave the federal government the ability to waive or modify certain requirements in a number of areas, including Medicare, Medicaid, CHIP and private health insurance. Additionally, Congress enacted laws – The Families First Coronavirus Response Act and The Coronavirus Aid, Relief, and Economic Security Act – that provided additional flexibilities related to the public health emergency. These flexibilities end when the public health emergency ends.

The flexibilities permitted under the declaration and the legislation include:

  • Elimination of cost sharing for receipt of COVID-19 vaccines, tests, test-related services and some treatments.
  • Expand Medicaid eligibility. States are required to provide continued eligibility for Medicaid enrollees beginning March 18, 2020. States are not permitted to transfer a Medicaid enrollee to another coverage group that offers a more restrictive benefit package.
  • Expand access to telehealth for Medicare, Medicaid, and CHIP beneficiaries.
  • Extension of timelines and notices for COBRA and other group health plan provisions. These include the COBRA premium payment date, the deadline for employers to notify individuals of their COBRA continuation rights, and the special 30-day election period for applying for membership in a group health plan.
The last day to change your Medicare participation status for 2023 is December 31 Wed, 09 Nov 2022 18:52:25 +0000

November 09, 2022

It’s that time of year again – time for doctors to decide if they want to make any changes to their Medicare membership status. Physicians have until December 31, 2022 to make changes for the 2023 membership year. The effective date of any changes will be January 1, 2023.

In making the decision for the 2023 Enrollment Year, physicians should be aware that the Centers for Medicare and Medicaid Services (CMS) recently released the final rule and policies for the next year. The price list has not yet been published.

As always, physicians have three choices regarding Medicare: be a participating provider; be a non-participating supplier; or remove yourself from Medicare altogether. Details on each of the three participation options are as follows:

A participating physician must accept Medicare-authorized charges as full payment for all Medicare patients. A participating supplier receives 5% more reimbursement than a non-participating supplier.

A non-participating supplier may make award decisions on a case-by-case basis and bill patients more than Medicare’s allowance for unassigned claims. The fees of non-participating physicians represent 95% of the fees of participating physicians. If you choose not to accept the assignment, you may charge the patient 9.25% more than the amounts allowed in the Participating Physician Fee Schedule (equivalent to 15% of the non-participating fee).

Doctors who retire Medicare are only bound by their private contracts with their patients. Medicare’s limit charges do not apply to these contracts, but Medicare specifies that these contracts contain certain conditions. When a physician enters into a private contract with a Medicare beneficiary, the physician and patient agree not to bill Medicare for services provided under the contract. As a result of the 2015 Medicare Access and CHIP Reauthorization Action (MACRA), validated opt-out affidavits signed on or after June 16, 2015 will be automatically renewed two years after the effective date.

Physicians wishing to change their participation status for 2023 must submit a Medicare Participating Physician or Provider Agreement (CMS-460) to Noridian, the California Medicare contractor, postmarked by December 31, 2022. The participation agreement will automatically renew each year. However, if there is a change of name or EIN (tax identification number), you will need to complete a new Participation Agreement.

There is also information about physicians’ Medicare participation options in the California Medical Association (CMA) Health Law Library: Document #7209, “Medicare Participation (and Nonparticipation) Options.” Health Law Library documents are free for members at Non-members can purchase documents for $2 per page.

Click here for more information on open enrollment on the Noridian website.

Contact: Cheryl Bradley, (916) 551-2862 or

Come back

]]> Biden-Harris administration bolsters Medicare with finalized policies to simplify enrollment and expand access to coverage – InsuranceNewsNet Sat, 29 Oct 2022 13:11:33 +0000

Baltimore, Maryland, October 28 — The US Department of Health and Social Services Centers for Medicare and Medicaid Services issued the following press release on October 28, 2022:

The Medicare and Medicaid Service Centers (CMS) released a final rule that updates Medicare enrollment and eligibility rules to expand coverage for people with Medicare and advance health equity. The final rule, which implements changes made by the Consolidated Appropriations Act of 2021 (CAA), makes it easier for people to enroll in Medicare and eliminates coverage delays. Among these changes, individuals will now have Medicare coverage the month immediately following enrollment, reducing coverage delays. In addition, the rule expands access through Medicare’s Special Enrollment Periods (SEPs) and allows certain eligible beneficiaries to receive Medicare Part B coverage without a late enrollment penalty.

The Biden-Harris administration made expanding access to health care a top priority, and under their leadership, more Americans than ever before have health insurance coverage. Today’s final rule builds on that success and supports the administration’s additional efforts to strengthen Medicare.

The Biden-Harris administration made it clear: We are committed to doing everything we can to strengthen Medicare,” the HHS secretary said. Xavier Becerra. “Today, we’re making it easier to enroll, expanding access, and eliminating coverage delays to improve Medicare for the millions of Americans who depend on it. We work tirelessly to deliver health insurance and peace of mind. that registrants deserve.”

“CMS is committed to ensuring that those eligible for Medicare have timely access to this vital coverage,” the CMS administrator said. Chiquita Brooks-LaSure. “For the first time, special enrollment periods will be available in traditional health insurance for people who were unable to enroll due to exceptional conditions, and people who have had kidney transplants will be able to now enjoy expanded Medicare coverage for immunosuppressive drugs.Each part of this essential rule advances CMS’s strategic vision to expand access to affordable, quality health care and coverage. . »

A Special Enrollment Period (SEP) allows individuals to make changes to their health coverage outside of a typical enrollment period. SEPs finalized in this rule provide the opportunity for eligible individuals to enroll in Part B if they did not enroll in Medicare during their initial enrollment period when they were first eligible, and to do so no late registration penalty. Examples of new SEPs created by this rule are SEPs for eligible individuals who miss an enrollment opportunity because: 1) they have been affected by a government-declared disaster or emergency; 2) their employer or health insurance plan has significantly misrepresented timely Medicare Part B enrollment information; 3) they were incarcerated; and 4) their Medicaid coverage was terminated after the end of the COVID-19 PHE or on or after January 1, 2023 (whichever comes first).

The final rule also establishes a new immunosuppressive drug benefit that extends lifesaving Medicare immunosuppressive drug coverage to certain people who have had kidney transplants and who would otherwise lose Medicare coverage. Changes finalized in this rule come into effect on January 1, 2023.

These changes not only implement important provisions of the Consolidated Appropriations Act of 2021 (CAA), but also support of President Biden Federal Customer Experience and Service Delivery Transformation Executive Orders for Rebuild trust in government and continues to strengthen Americans’ access to affordable, quality health care coverage by eliminating confusing wait times and allowing CMS and the Social Security Administration to address missed enrollment periods by allowing eligible individuals to enroll in Medicare Part B through SEPs for exceptional terms. Additionally, these changes support the Administration’s vision for CMS: to serve the public as a trusted partner and steward, dedicated to advancing health equity, expanding access to coverage and affordable care and improved health outcomes.

“These changes underscore CMS’s efforts to advance health equity and improve access to Medicare,” said Dr. Meena Seshamanideputy administrator of the CMS and director of the health insurance center. “Reducing coverage gaps, allowing special enrollment periods for people in exceptional circumstances, spending money smarter on kidney transplant patients – these are meaningful changes that put people at the center of their care and improve the Medicare program.”

Finally, CMS is making several technical updates to improve the administration of Medicare savings programs. These programs help make health insurance affordable for those struggling to pay for health care.

CMS encourages people approaching Medicare eligibility to research their Medicare coverage options and enrollment deadlines. Both and 1-800-MEDICARE are available to help people understand their choices and associated timelines. In addition, personalized health insurance counseling is available free of charge from State Health Insurance Assistance Programs (SHIPs). Visit or call 1-800-MEDICARE for the phone number for each SHIP.

Medicare Open Enrollment works from October 15 to December 7, 2022. Meanwhile, those eligible for Medicare can compare 2023 coverage options on provides clear, easy-to-use information and an updated health insurance plan search tool to help people compare health and drug coverage options, which may change from year to year. in year.

Medicare Plan Finder has been updated with the 2023 Medicare Health and Prescription Drug Plan information at October 1, 2022. 1-800-MEDICARE is also available 24 hours a day, seven days a week to provide help in English and Spanish as well as language support in more than 200 languages. People who want to keep their current Medicare coverage do not need to re-enroll.

During open enrollment, people with Medicare who take insulin are encouraged to call 1-800-MEDICARE or contact their state health insurance assistance programs (https://www. for help comparing plans and costs this year.

To view a fact sheet on the final rule, visit: medicare-2

To view the final rule, visit:

* * *

Original text here:

Helpful Tips for Navigating Medicare Open Enrollment for 2023 Thu, 27 Oct 2022 10:23:42 +0000 The world of Medicare/Medicaid can be extremely confusing.

Each year, open registration takes place from October 15 to December 15. 7. It allows individuals to review and make changes to their Medicare Part D prescription plans and Medicare Advantage plans. Authorized changes include monthly premiums, annual deductible copayments, prescription copayments, prescription form (list of drugs covered) and pharmacy network.

This process can be overwhelming – how do you know which option is right for you? Here are some tips for navigating open enrollment season:

Know the difference between Medicare and Medicaid. “Medicare is a medical program for people over 65 and younger people with disabilities and dialysis patients. Medicaid is a medical expense assistance program for low-income patients,” explains the US Department of Health and Human Services.

‘The most intense advocacy effort of my life’: Home health industry braces for rate cuts Mon, 24 Oct 2022 05:39:06 +0000

Any day now, the home health final payment rule will be officially released by the Centers for Medicare & Medicaid Services (CMS).

As providers await his arrival, many of them are gathered in St. Louis at the annual conference of the National Association for Home and Hospice Care (NAHC). If the final rule is as bad – or nearly as bad – as the proposed rule, it will be a dark day for the industry.

It won’t be due to a lack of effort, however.

The main thing we are looking at is the 7.69% rate cut – will that happen or not? NAHC President William A. Dombi said at the conference Sunday. “We have been engaged in the most intense advocacy effort I have experienced in my life. And I’ve been doing advocacy for a few years. The effort we have underway brings all forms of advocacy.

Unlike years past where a certain provision could cause concern for providers in the proposed rule, this year’s one – if finalized as proposed – will threaten their very existence.

Dombi noted that about 51% of home care providers would be operating in the red if the rate reduction materialized for 2023, according to an NAHC analysis.

This number also assumes that agencies will not change the way they run their businesses. Of course, they will have to if there is an overall 4.2% decrease in home health rates.

There are also concerns that the estimated 4.2% cut could be more severe than CMS suggests.

“First of all, just this overall impact,” Scott Pattillo, chief strategy officer at Homecare Homebase, told Home Health Care News earlier this month. CMS predicted that the proposed rule this year would result in a 4.2% reduction in the industry. Across all of our aggregated models, using 36% of the data – which we think is a pretty good representative sample – we see a 5% reduction in reimbursement. This will create an even greater impact on access to care.

That’s why NAHC and others have taken this three-pronged approach to advocacy: the regulatory front, with Congress on the Preserving Home Health Care Act, and preparing for a legal battle when the rule is finalized.

Dombi also noted that this is strong support for the home health industry as it battles rate cuts in Washington, DC. That support is on both sides of the aisle, and in Congress and the Senate.

“Our allies in Congress have stepped up beyond anything I’ve ever experienced,” Dombi said.

Although a proverbial dark cloud hung over the speech, the preparation and advocacy the industry took gave hope to Dombi and other leaders as final rule approached.

“The CMS administrator probably had nauseating conversations at this point with members of Congress, with us, and with many others,” Dombi said. “We are on the edge of our seats waiting to see what happens. If we give a blind prediction, the prediction is that we think we are in on it. We have a meeting scheduled no later than Thursday of this week with the director of the Office of Management and Budget. They wouldn’t give us this meeting if they didn’t want to hear what we had to say again.

The aforementioned legal battle would come after a negative final rule is finalized and possibly even after these rates are implemented in 2023.

Given the recent success of hospitals in fighting a rate cut in court — as well as other general legal trends in the United States — home health officials are right to believe they would have a strong case. against CMS and the US Department of Health and Human Services.

“We always consider litigation as a last resort,” Dombi said. “At this time, we have carefully prepared the legal arguments presented both on the regulatory front and in Congress along the way, and we will do everything we can to protect your interests. The only thing I believe this advocacy staff does as well as anyone, if not better than anyone else is that he doesn’t give up and you don’t either, so we look forward to teaming up with you in as we will need it in the future.

Dissecting the White House’s twist on Social Security and Medicare Fri, 21 Oct 2022 07:06:11 +0000


“Social Security checks are going up. Health insurance premiums are falling. This is a big problem for older people.

— President Biden, in a tweetOctober 14

This is a case where there must be a huge asterisk next to a politician’s statement. Social security benefits are increase next year – and health insurance premiums are will fall. “For the first time in more than a decade, seniors’ health insurance premiums will go down even as their Social Security checks go up,” boasted White House press secretary Karine Jean. -Pierre, in a press release.

But the reasons are not so good for seniors.

For months, Biden signaled he was taking aggressive action to tackle inflation, which by one measure rose to 8.2% for the 12 months ending September. This is a stark contrast to the 1-2% inflation rate that was the norm during the previous decade. Prices rose 9.1% in the 12 months to June.

The reason Social Security payments increase is that Social Security benefits, unlike virtually all annuities, are adjusted each year to keep pace with inflation as measured by the home price index. consumption from the Ministry of Labor (IPC-W). Thus, the benefits are always increasing, which makes it very valuable for retirees.

On October 13, the Social Security Administration announced that benefits would increase by 8.7%, for an average increase of more than $140. That sounds like a lot, but in theory, it just allows older people to keep pace with the rising cost of living.

Whether the CPI-W is the appropriate mechanism for such annual adjustments is a matter of debate. The CPI is based on household surveys and measures the increase in costs of a basket of goods purchased by urban consumers. The BLS has toyed with the formula often, sometimes under pressure from lawmakers worried about the federal budget deficit, due to concerns that the measure overstates inflation. In the 1990s, the annual inflation rate as measured by the CPI was reduced by nearly one percentage point as a result of technical adjustments made by the BLS. Without these adjustments, Social Security benefits would be even higher today.

In addition, other inflation indicators, such as the one that measures costs for producers or the one that measures prices for urban and rural consumers, could more accurately reflect changes in the cost of living.

The reality is that if Biden and the Federal Reserve’s efforts to fight inflation were more effective, Social Security benefits would not rise as much.

Medicare Part B is the part of the senior health program that covers physician and outpatient services. Seniors pay a monthly fee. Biden is correct that the bounty will drop next year. Premiums were $170.22 per month in 2022 and will be $164.90 next year. That’s a decrease of about 3 percent.

This seems like good news. But premiums had soared in 2022, rising by $21.60, or 14.5%, one of the largest increases in recent history. Premiums were $148.50 in 2021.

In other words, while premiums decline slightly in 2023, they are still $16.40 higher than in 2021. That’s an 11% increase over two years.

The annual deductible would also drop from $233 in 2022 to $226 in 2023, a decrease of $7. But, again, the annual deductible from the previous year had increased by $30. So overall, deductibles are also 11% higher than two years earlier.

The Centers for Medicare & Medicaid Services said they raised premiums so much in 2022, in part because they had to add reserves to cover a new Alzheimer’s drug given by a doctor at a clinic or a hospital. The drug, known as Aduhelm, was expected to cost $56,000 a year. But Biogen, the manufacturer, cut the price by almost half – to $28,200. This left the program with excess reserves that are now passed on to those covered by Medicare Part B.

But, for the elderly, the modest reductions in the coming year will not compensate for the large increases in the previous year.

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]]> Implementation of medically adapted meal programs associated with cost savings Tue, 18 Oct 2022 21:02:54 +0000

Implementing programs that provide medically appropriate meals (MTMs) to people with diet-sensitive diseases can be linked to both better health outcomes and significant cost savings.

New research from researchers at Tufts University’s Friedman School of Nutrition Science and Policy suggests that MTMs lead to fewer hospitalizations nationwide, as well as a net savings of $13.6 billion per year. year.

“The goal of MTMs is first and foremost to improve health and well-being, and while the potential for savings is very encouraging, that should not be the only reason to invest in these and other programs. that meet nutrition-related needs,” study author Kurt Hager, MS said in an accompanying statement. “At the same time, the results are quite extraordinary. It is very rare to have cost savings in health care.

The interest of health care systems, patients and policy makers in the concept of food as “medicine” has been accompanied by a rapid increase in the availability of nutrition programs for patients with diseases chronicles. Medically Adapted Meals are personalized, fully prepared home-delivered meals for patients with advanced illnesses, but limited coverage for NTMs exists nationwide because neither Medicaid nor Medicare provides them as a covered benefit.

The present study analyzed data on the 1- and 10-year associations of MTMs with hospitalizations, healthcare expenditures, and net costs in patients with ≥1 diet-related illnesses and ≥1 instrumental activities of daily living (IADL) that are covered by Medicaid, Medicare, and private insurance.

The study sample for the economic evaluation was drawn from the 2019 Medical Expenditure Panel Survey, with the study conducted from January 2021 to February 2022. Diet-sensitive conditions included diabetes, congestive heart failure, myocardial infarction, other heart diseases, emphysema and strokes. , as well as non-melanoma cancer, chronic kidney disease and HIV infection.

Investigators estimated that a total of 6,309,998 American adults with Medicare, Medicaid and private insurance were eligible to receive MTMs. The average age was 68.1, with most being female (63.4%), non-Hispanic white (66.7%), and having Medicare and/or Medicaid (76.5%).

The most common qualifying diagnoses were cardiovascular disease (70.6%), diabetes (44.9%) and cancer (37.2%).

A meta-analysis of 5 previously completed studies found that implementing MTM was associated with reductions in annual healthcare expenditure of 19.7% (95% confidence interval [CI]6.9% – 32.4%) and annual hospitalizations of 47.0% (95% CI, 31.7% – 62.3%), compared with usual care.

If all eligible patients received MTMs, the current results indicate that the costs of the program would be $24.8 billion (95% uncertainty interval [UI], $23.1 billion to $26.8 billion). An estimated 1,594,000 hospitalizations (95% UI, 1,297,000 – 1,912,000) and 38.7 billion (95% UI, 24.9 – 53.9 billion ) in healthcare costs could be avoided within 1 year.

For all health care payers, the policy was estimated to result in associated net savings of $13.6 billion (95% UI, $0.2 billion to $28.5 billion).

Over 10 years, the MTM intervention is projected to cost $298.7 billion (95% UI, $279.7 billion to $317.4 billion) and potentially be associated with hospitalization reductions of 18,257,000 (95% unemployment insurance, 14,690,000 – 22,109,000) and cuts in health care spending. $484.5 billion (95% UI, $310.2 billion to $678.4 billion).

Net cost savings would be $185.1 billion (95% UI, $12.9 billion to $377.8 billion) if the target population received MTMs for 8 months per year during each of the 10 years modeled.

“For people with chronic conditions and physical limitations that prevent them from shopping and cooking for themselves, these programs are a very promising strategy for improving health and well-being,” Hager added. “The estimated reductions in hospitalizations and associated cost savings reflect this.”

The study, “Association of National Expansion of Insurance Coverage of Medically Tailored Mealor with Estimates Hospitalizations and Health Care Expenditures in the US,” was published in Open JAMA Network.