Advocacy Update – November 2023: CMS Changes Definition of Medicare Caregiver in New Rule

Published 11/29/23

President Biden Signs Funding Bill, Averting a Government Shutdown

On November 16, President Biden signed the stopgap funding bill passed by the House and Senate. The short-term two-tiered spending bill includes temporary extensions of expiring health programs through January 19, including funding for community health centers, the National Health Service Corps, the Special Diabetes Programs and preventing cuts to the Medicaid Disproportionate Share Hospital (DSH) program. The bill is designed to buy more time for the House to pass appropriations bills and for House and Senate negotiators to reach a deal on funding. The House has passed seven of the 12 annual appropriations bills that fund the government for a full fiscal year, while the Senate has passed three. The short-term bill extends funding for four appropriations bills through January 19, 2024, and the remaining eight appropriations bills through February 2, 2024. 

Congressional Hearing on Telehealth Permanency

UMDF members were instrumental in legislation passed last year extending several COVID-19-related telehealth flexibilities through the end of 2024, including geographic and originating site flexibilities, meaning patients can continue to receive care via telehealth in their homes, which is critical to mitochondria patients. 

Last week, the Senate Finance Health Care Subcommittee discussed efforts to ensure continued access to telehealth benefits for Medicare beneficiaries. Committee members on both sides of the aisle expressed support for the continuation of Medicare telehealth flexibilities that began during the COVID-19 public health emergency. Witnesses also highlighted key flexibilities that should be permanent, such as eliminating geographic restrictions for providing telehealth so that it can continue to be provided in Medicare beneficiaries’ homes, expanding telehealth services offered, allowing audio-only care for Medicare beneficiaries, and expanding provider types permitted to provide telehealth. Most current Medicare telehealth flexibilities are set to expire on December 31, 2024, without congressional action. The desire to extend telehealth flexibilities is seen as a driver for action on healthcare policies in 2024.

Medicare Final Rule Covers Training for Family Caregivers and Expands Telehealth

The finalized 2024 Medicare Physician Fee Schedule (MPFS) final rule will increase telehealth access and expand access to caregiver training services. CMS will now pay for certain caregiver training services in specified circumstances so that practitioners are paid to engage with caregivers to support people with Medicare and their caregivers in carrying out their treatment plans. The Final Rule includes a definition of caregiver that’s broader than CMS’ earlier definition, which had limited the term to relatives of the beneficiary. The new definition expands “caregiver” to include “an adult family member or other individuals who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation,” and “a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition.” This is hopefully the first in a wide range of Medicare policy changes that could help families care for beneficiaries and create a more equitable system of home-based care.

Regarding telehealth, CMS temporarily extended many policies in the CY 2024 Medicare Physician Fee Schedule Final Rule, and the Agency is waiting to see how Congress (as discussed above) responds before putting forward more permanent telehealth policies. That puts much pressure on Congress to develop a long-term telehealth strategy within the following year. If Congress chooses not to act, CMS will decide which policies, if any, to extend or make permanent in its CY 2025 rulemaking.