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Once again, health equity has been front and center during this year’s federal regulatory season. Recently, the Centers for Medicare and Medicaid Services (CMS) announced a new model to promote health equity and the U.S. Department of Health and Human Services (HHS) proposed rule updates to protect patients with disabilities. CMS’ new States Advancing All-Payer Health Equity Approaches and Development (States Advancing AHEAD) Model will provide select states with limited supplemental funding for programs aimed at lowering health care costs and eliminating health inequities. HHS’ latest proposed antidiscrimination policy aims to promote health equity for those with disabilities and makes regulatory updates for better alignment and clarity. The States Advancing AHEAD Model: CMS will award up to $12 million to eight participating states over a six-year span through a new payment model: the States Advancing AHEAD Model. In return, participating states will be held accountable for meeting certain quality, cost, and health equity targets that align with the Model’s goals. AHEAD has several health equity components, including the following:

• States must establish a governance structure consisting of stakeholders with a wide range of perspectives to inform activities and build partnerships.
• Like the REACH model, all participating states and hospitals will be required to develop Health Equity Plans to define and guide activities aimed at reducing disparities and improving population health.
• Payments will include adjustments for a patient’s social risk. Hospitals will also be eligible to earn a bonus for improved performance on disparity-focused measures.
• Participating providers will enhance demographic data collection and utilize health-related social needs screening to connect beneficiaries to community resources.
• Primary Care AHEAD participants will be required to engage in state Medicaid transformation efforts, meet care transformation requirements for person-centered care, and reach quality performance goals.

According to the announcement from CMS, the Model is based on successful state-based initiatives in Maryland, Pennsylvania, and Vermont. Some comparisons are also being made to a similar nation-wide model rolled out by CMS in 2020 – the Community Health Access and Rural Transformation Model – which was ended by the Agency in 2022 due to lagging adoption in rural areas. HHS Proposed Rule Updates to Protect Those with Disabilities: HHS announced a proposed a rule aimed at promoting health equity and bolstering protections for people with disabilities. The proposed rule updates, clarifies, and strengthens regulations under the Rehabilitation Act of 1973 – the statute that prohibits discrimination against otherwise qualified individuals based on disability. Some of the key updates proposed include:

• Ensuring that medical treatment decisions are not based on biases or stereotypes about individuals with disabilities, judgments that an individual will be a burden on others, or beliefs that the life of an individual with a disability has less value than the life of a person without a disability.
• Prohibiting the use of value assessment methods that discriminate against individuals with disabilities by placing a lower value on life-extension for individuals with disabilities when that method is used to limit access or deny aids, benefits, or services.
• Establishing enforceable standards for medical diagnostic equipment including requiring providers to have at least one accessible exam table and weight scale.
• Incorporating changes made to the Rehabilitation Act through the Americans with Disabilities Act (ADA) and other legislation and case law; specifically addressing service animals, ADA compliance standards for facilities and equipment, mobility devices, etc.

To learn more about the proposed rule, check out the HHS Fact Sheet.