The Centers for Medicare and Medicaid Services in April released its framework for health equity, seeking to revamp its approach to addressing the needs of underserved communities.
The framework is the agency’s plan to address the imbalance in benefits and opportunities underserved communities experience. The framework is CMS’s update to its previous plan, and the framework is a more comprehensive, 10-year approach to imbue equity considerations into all of the agency’s programs, including not only Medicare, but Medicaid, CHIP, and the Health Insurance Marketplaces.
As the largest provider of health insurance in the nation, facilitating the health care and coverage of over 170 million people, CMS’s efforts will most certainly impact the entire landscape of the country’s health-care delivery system. In its efforts to target “underserved communities,” CMS paints with a broad brush to address the concerns of not only members of racial and ethnic communities, but also people with disabilities; members of the LGBTQ+ community; individuals 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 enhance CMS’ ability to ascertain if—and to what extent—its programs and policies “perpetuate or exacerbate systemic barriers to opportunities and benefits” among underserved communities.
Implementing the Framework
CMS intends to implement its framework by addressing five stated priorities.
First is expanding the collection and use of data collection from historically underserved communities. Second is assessing CMS’ programs for causes of disparities and addressing policies and operations that may contribute to inequities. Third is building the “collective capacity” of health-care organizations and the workforce to reduce disparities. Next is advancing language access, health literacy, and culturally tailored services to alleviate the burden that disparities in these areas play in health outcomes. And finally, facilitating health-care organizations and providers to increase accessibility to services and coverage for the one in four American adults having some form of disability.
CMS has outlined its planned implementation by emphasizing the reach and accomplishments of current programs and the agency’s intention to expand some aspects of these programs in support of its decade-long plan to “achieve health equity and eliminate disparities.” The agency has already begun to put its plan to achieve its priorities into action.
CMS recently announced the availability of grant funds to support the design and testing of interventions that may reduce disparities in underserved communities. It also has released a fact sheet listing some of the most pressing barriers to health equity and identifying CMS resources to assist in addressing those barriers.
The framework is a positive first step to addressing a significant need. However, the devil is in the details.
The framework describes how some of its current programs factor into the program’s implementation but does not provide information sufficient to fully analyze how CMS will address some of the critical barriers that its plan may face in implementation.
For example, the framework depends on collecting new and more types of data to bolster many of CMS’ current programs. Adding new data elements, however, poses additional privacy concerns.that CMS must proactively address.
External stakeholders tasked with collection of this additional data must confirm that they follow patient privacy laws and that all collected data is secure from breach. Providers must also ensure adherence to 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 the proper consents or properly guard information from potential breach may inadvertently subject providers and external stakeholders to liability.
Reviewing the Conditions of Participation and/or Coverage
Another option to address issues of health equity and disparities discussed in the framework is to review the conditions that that the CMS says “organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs.”
CMS projects that these efforts will help the agency to identify and eliminate potential barriers to enrollment in and access to CMS benefits and services by underserved communities. There is no additional discussion, however, or example of the type of changes that may be proposed.
Health-care organizations must meet the conditions in order to participate in the Medicare and Medicaid programs, and the conditions direct standards regarding quality concerns and the protection of beneficiaries.
It is essential that any proposed changes consider not only the possible impacts to improving health equity, but also the impacts to organizations. Health-care organizations are given little information in the framework regarding what may come, which may leave organizations ill-prepared to respond.
CMS Gives Insufficient Guidance
CMS has provided a detailed framework that previews many of the programs it intends to augment or redirect to accomplish its goal of achieving health equity and eliminating disparities, but does not provide sufficient guidance to determine how some of the solutions it might consider would impact providers. The agency provides in the framework the “how,” but not the “what.”
Health-care organizations can begin to prepare for the “what” by using their own internal programs to address health equity issues and sharing their experiences to help guide CMS in fleshing out the framework’s details.
CMS’s next iteration of guidance regarding its framework should provide more detailed information regarding the initiative’s legal and administrative impacts so that providers can assess the potential effects of the proposed solutions and better assist CMS in achieving its crucial goals.
Until then, health-care organizations and providers seeking to partner with CMS in its efforts to improve health equity and reduce health disparities will be left in search of a destination without a map.
This article does not necessarily reflect the opinion of The Bureau of National Affairs, Inc., the publisher of Bloomberg Law and Bloomberg Tax, or its owners.
Janelle Alleyne is an attorney in the Health Law and Litigation practices at Baker, Donelson, Bearman, Caldwell & Berkowitz P.C. in Atlanta. She concentrates her practice in health-care regulation and compliance and complex tort litigation.
Stefanie Jones Doyle is an attorney with the Health Law practice at Baker, Donelson, Bearman, Caldwell & Berkowitz P.C. in Washington, D.C. She represents clients on a range of health-care regulatory and compliance matters, with a focus on post-acute and long-term care providers.