The Centers for Medicare and Medicaid Services in April released its Health Equity Framework, seeking to overhaul its approach to addressing the needs of underserved communities.
The framework is the agency’s plan to address the imbalance in benefits and opportunities in underserved communities. The framework is CMS’s update to its previous plan, and the framework is a more comprehensive, 10-year approach to building equity considerations into all of the agency’s programs, including not only Medicare but also Medicaid, CHIP and the Health Insurance Marketplaces.
As the nation’s largest health insurance provider, facilitating health care and coverage for more than 170 million people, CMS’ efforts are sure to impact the entire landscape of the nation’s health care delivery system. In its efforts to target “underserved communities,” CMS paints with a broad brush to address the concerns not only of members of racial and ethnic communities, but also of people with disabilities; members of the LGBTQ+ community; persons with limited English proficiency; members of rural communities; and those who otherwise experience the adverse effects of persistent poverty and inequality.
The framework is designed to improve CMS’s ability to identify whether — and to what extent — its programs and policies “perpetuate or exacerbate systemic barriers to opportunity and benefit” among underserved communities.
Implementation of the framework
CMS intends to implement its framework by addressing five stated priorities.
The first is expanding the collection and use of data collection from historically underserved communities. The second is evaluating CMS programs for the causes of disparities and addressing policies and operations that may contribute to the disparity. Third is building the “collective capacity” of health organizations and the workforce to reduce disparities. Next is improving language access, health literacy, and culturally responsive services to alleviate the burden that disparities in these areas place on health outcomes. Finally, making it easier for healthcare organizations and providers to increase access to services and coverage for the one in four American adults with some form of disability.
CMS outlined its planned implementation, highlighting the scope and accomplishments of current programs and the agency’s intent to expand some aspects of those programs in support of its 10-year plan to “achieve health equity and eliminate disparities.” The agency has already started implementing its plan to achieve its priorities.
CMS recently announced the availability of grants to help design and test interventions that can reduce disparities in underserved communities. It also published a fact sheet listing some of the most pressing barriers to health equity and identifying CMS resources to help address those barriers.
The framework is a positive first step towards addressing a significant need. However, the devil is in the details.
The framework describes how some of its current programs affect program implementation, but does not provide information sufficient to fully analyze how CMS will address some of the critical barriers its plan may face in implementation.
For example, the framework depends on the collection of new and more types of data to strengthen many of CMS’ current programs. However, the addition of new data elements creates additional privacy concerns that CMS must proactively address.
External stakeholders tasked with collecting this additional data must confirm that they comply with patient privacy laws and that all data collected is protected against tampering. Providers must also ensure compliance with all federal and state privacy laws that require written consent from patients before their health information is released to other people and organizations.
Failure to obtain appropriate consents or properly protect information from potential breach may inadvertently expose suppliers and external stakeholders to liability.
Review terms of participation and/or coverage
Another option to address the health equity issues and disparities discussed in the framework is to revise the conditions that CMS says “organizations must meet to begin and continue to participate in the Medicare and Medicaid programs.”
CMS anticipates that these efforts will help the agency identify and eliminate potential barriers to enrollment and access to CMS benefits and services by underserved communities. However, there is no further discussion, or an example of the type of changes that might be proposed.
Health care organizations must be eligible to participate in the Medicare and Medicaid programs, and eligibility guides standards regarding quality concerns and beneficiary protection.
It is essential that any proposed changes consider not only the potential impacts on improving health equity, but also the impacts on organizations. Healthcare organizations receive little information in the framework about what might happen, which can leave organizations ill-prepared to respond.
CMS provides insufficient guidance
CMS has provided a detailed framework that visualizes many of the programs it intends to expand or realign to achieve its goal of achieving health equity and eliminating disparities, but it does not provide enough guidance to determine how some of the decisions it might make to consider would affect suppliers. The agency provides the ‘how’ but not the ‘what’ in the framework.
Healthcare organizations can begin preparing for the “what” by using their own internal programs to address health equity issues and sharing their experiences to help CMS guide the details of the framework.
The next iteration of CMS’ guidance on its framework should provide more detailed information on the legal and administrative impacts of the initiative so that providers can assess the potential effects of proposed solutions and better assist CMS in achieving its goals. key objectives.
Until then, health care organizations and providers looking to partner with CMS in its efforts to improve health equity and reduce health care disparities will be left searching for a destination without a map.
This article does not necessarily reflect the views of The Bureau of National Affairs, Inc., publisher of Bloomberg Law and Bloomberg Tax, or its owners.
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Janelle Alleyne is an attorney in the health law and litigation practices at Baker, Donelson, Bearman, Caldwell & Berkowitz PC in Atlanta. She focuses her practice in healthcare regulatory and compliance and complex tort litigation.
Stephanie Jones Doyle is an attorney in the health law practice at Baker, Donelson, Bearman, Caldwell & Berkowitz PC in Washington, DC. She represents clients on a range of health care regulatory and compliance matters, with an emphasis on post-acute and long-term care providers.