The Centers for Medicare and Medicaid Services in April released it frame for health equity, seeking to renew its approach to addressing the needs of underserved communities.
The Framework is the agency’s plan to address the disparity in benefits and experiential opportunities of underserved communities. The framework is the CMS update with the previous one planand the framework is a more comprehensive, 10-year approach to embed equity considerations in all of the agency’s programs, including not only Medicare but Medicaid, CHIP and the Health Insurance Marketplaces.
As the nation’s largest health insurance provider, facilitating health care and coverage for over 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; individuals with limited English skills; members of rural communities; and those who otherwise experience the negative effects of persistent poverty and inequality.
The framework is designed to enhance CMS’s ability to ascertain 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 the five stated priorities.
First is expanding the collection and use of data collection from historically underserved communities. The second is to assess CMS programs for the causes of disparities and address policies and operations that may contribute to disparities. Third is building the “collective capacity” of health care organizations and the workforce to reduce disparities. The other is to advance language access, health literacy, and culturally appropriate services to alleviate the burden that disparities in these areas play on health outcomes. And finally, making it easier for health care organizations and providers to increase access to services and coverage for the one in four American adults who have some form of disability.
CMS has outlined its planned implementation by highlighting the scope and achievements of current programs and the agency’s intention to expand some aspects of these programs in support of its ten-year plan to “achieve health equity and eliminate disparities.” The agency has already begun to implement its plan to achieve its priorities.
CMS recently announced the availability of grant funds to support the design and testing of interventions that can reduce disparities in underserved communities. She has also released a fact sheet listing some of the most pressing barriers to health equity and identifying CMS resources to help address these barriers.
The framework is a positive first step in addressing an important need. However, the devil is in the details.
The framework describes how some of its current programs affect program implementation, but does not provide enough information to fully analyze how CMS will address some of the critical barriers its implementation plan may face.
For example, the framework depends on collecting new types and more data to strengthen many of the current CMS programs. However, the addition of new data elements presents additional privacy concerns. which CMS must proactively address.
Third parties charged with collecting this additional data must confirm that they follow patient privacy laws and that all data collected is secure from breaches. 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 breaches may inadvertently subject providers and external stakeholders to liability.
Review of conditions of participation and/or coverage
Another option to address the health equity and disparities issues discussed in the framework is to revise the conditions that CMS says “organizations must meet in order to begin and continue to participate in the Medicare and Medicaid programs.”
CMS projects 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 example of the type of changes that might be proposed.
Health care organizations must meet requirements to participate in the Medicare and Medicaid programs, and the requirements guide 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 are given little information about what might happen, which can leave organizations unprepared to respond.
CMS provides insufficient guidance
CMS has provided a detailed framework that outlines many of the programs it intends to add or redirect to meet its goal of achieving health equity and eliminating disparities, but it does not provide sufficient guidance to determine how some of the solutions that may be to consider will affect providers. The agency provides the “how” framework, but not the “what”.
Healthcare organizations can begin to prepare for “what” by using their own internal programs to address health equity issues and sharing their experiences to help guide CMS in fleshing out the details of the framework.
The next iteration of CMS’ guidance on its framework should provide more detailed information about 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 core goals.
Until then, organizations and health care providers seeking to partner with CMS in its efforts to improve health equity and reduce health disparities will be left searching for a destination without a map.
This article does not necessarily reflect the opinion of the Bureau of National Affairs, Inc., publisher of Bloomberg Law and Bloomberg Tax, or its owners.
Information about the author
Janelle Alleyne is an attorney in the health law and litigation practice at Baker, Donelson, Bearman, Caldwell & Berkowitz PC in Atlanta. She focuses her practice on healthcare regulatory and compliance and complex tort litigation.
Stephanie Jones Doyle is an attorney with the Health Law practice at Baker, Donelson, Bearman, Caldwell & Berkowitz PC in Washington, DC. She represents clients in a variety of health care regulatory and compliance matters, with a focus on post-acute and long-term care. providers.