CMS’s health equity framework sets goals without specifics

CMS’s health equity framework sets goals without specifics

The Centers for Medicare and Medicaid Services in April released the Health Equity Framework, seeking to renew its approach to addressing the needs of underserved communities.

The framework is the organization’s plan to address the imbalance of benefits and underserved opportunities that communities experience. The framework is CMS’ update to its previous plan, and the framework is a more comprehensive, 10-year approach to embedding equity issues in all of the agency’s programs, including not only Medicare, but also Medicaid, CHIP and the Insurance Marketplaces Health.

As the nation’s largest health insurance provider, facilitating health care and coverage for more than 170 million people, CMS’ efforts will certainly 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 individuals with disabilities. members of the LGBTQ+ community; people 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’s ability to determine whether—and to what extent—its programs and policies “perpetuate or exacerbate systemic barriers to opportunity and benefit” among underserved communities.

Application 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 to evaluate CMS programs for causes of disparities and to address policies and operations that may contribute to disparities. The third is building the “collective capacity” of health care organizations and the workforce to reduce disparities. Next is the promotion of language access, health literacy, and culturally appropriate services to mitigate the burden that disparities in these areas play on health outcomes. And finally, enabling organizations and health care providers to increase accessibility to services and coverage for the one in four American adults who have some form of disability.

CMS described its planned implementation by emphasizing the reach and accomplishments of current programs and the agency’s intent to expand some aspects of those programs to support its long-term 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 grant funds to support the design and testing of interventions that may reduce disparities in underserved communities. It also released a fact sheet that lists some of the most pressing barriers to health equity and identifies CMS resources to help address those 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 sufficient information to fully analyze how CMS will address some of the critical obstacles its plan may face during application.

Data privacy

For example, the framework depends on collecting new and more types of data to enhance many of CMS’ current programs. However, the addition of new data elements raises additional privacy concerns. CMS must address proactively.

External stakeholders charged with collecting this additional data must confirm that they follow patient privacy laws and that all data collected is secure from tampering. Providers must also ensure compliance with all federal and state privacy laws that require written consent from patients before sharing their health information with other individuals and organizations.

Failure to obtain appropriate consents or properly protect information from potential breach may inadvertently burden providers and external stakeholders.

Revision of Conditions of Participation and/or Coverage

Another option for addressing health equity and disparities issues discussed in the context is to review 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. There is no further discussion, however, or example of the type of changes that might be suggested.

Health care organizations must meet conditions to participate in the Medicare and Medicaid programs, and the conditions direct standards regarding quality issues and beneficiary protection.

It is important that any proposed changes consider not only the potential impact on improving health equity, but also the impact on organisations. Healthcare organizations receive little information in the context of what might happen, which can leave organizations ill-prepared to respond.

CMS provides insufficient guidance

CMS has provided a detailed framework that previews many of the programs it plans to increase or redirect to achieve its goal of achieving health equity and eliminating disparities, but it does not provide sufficient guidance to identify how some of the solutions it may consider will affect providers. The organization provides the “how” but not the “what” of the framework.

Healthcare organizations can begin to prepare for the “what” by using their own internal programs to address health equity issues and by sharing their experiences to help CMS flesh out the details of the framework.

CMS’s next iteration of guidance on its framework should provide more detailed information on the legal and administrative implications of the initiative so that providers can assess the potential impacts of proposed solutions and better assist CMS in achieving of its critical objectives.

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.

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Author information

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 on healthcare regulation and compliance and complex litigation.

Stephanie Jones Doyle is an attorney with the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz PC in Washington, DC He represents clients in a range of health care regulatory and compliance matters, with an emphasis on post-acute and long-term care providers.

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