Purpose of the Document:
The recently published CMS Fiscal Year (FY) 2025 Congressional Justification of Estimates for Appropriations Committees details the proposed budget for the coming fiscal year. The document illustrates how CMS plans to allocate funds across various programs, with a particular focus on technology and modernization investments. It outlines the challenges, goals, and strategies in delivering high-quality healthcare services, reducing healthcare disparities, and enhancing overall program efficiency.
Below we detail some of the projected Technology and Modernization Funds in FY 2025:
Introduction
In FY 2025, CMS aims to maintain its position at the forefront of healthcare innovation, ensuring efficient delivery of healthcare services while promoting health equity and expanding coverage. The proposed budget emphasizes significant investments in technology and modernization across its programs. This article examines where these funds are flowing and identifies areas where funding has significantly increased.
Funding Overview
CMS requests a total of $4.329 billion in discretionary appropriations for Program Management in FY 2025, reflecting an increase of $204.3 million from FY 2023 (p. 15). This funding supports mission-critical operations, ensuring CMS continues serving its beneficiaries and fulfilling legislative responsibilities. Technology and modernization initiatives are core to this effort.
Key Areas of Technology and Modernization Funding
Information Technology (IT) Infrastructure and Modernization
CMS’s FY 2025 budget allocates $2.979 billion for Program Operations (p. 23). A significant portion of these funds will enhance IT infrastructure, cybersecurity, and data management. Key initiatives include:
- Enterprise Data and Analytics: Strengthening the Office of Enterprise Data and Analytics (OEDA) will improve CMS’s ability to use data effectively, driving policy decisions, quality improvement, and program integrity (p. 4). The IT funding will support advanced analytics platforms, data sharing, and predictive modeling to prevent fraud, waste, and abuse.
- Cloud Modernization: CMS is moving towards cloud-based infrastructure for greater flexibility, scalability, and security. Investments in the Center for Clinical Standards and Quality (CCSQ) and Federal Marketplaces will ensure seamless data integration and enhance user experiences (p. 23).
- Medicaid Enterprise Systems (MES): Funding will continue the modernization of state Medicaid IT systems, with CMS providing enhanced technical support for state-level implementations (p. 28).
Cybersecurity Investments
CMS recognizes the importance of protecting sensitive health data. Cybersecurity funding increases are aimed at ensuring resilience against cyber threats. The FY 2025 budget supports cybersecurity efforts through:
- Risk Management Framework Implementation: The Office of Information Technology (OIT) will implement a comprehensive risk management framework to secure Medicare and Medicaid systems (p. 13).
- Multi-Factor Authentication (MFA): CMS will expand MFA to all beneficiary and provider portals, reducing unauthorized access risks (p. 229).
Program Integrity and Fraud Prevention
CMS is allocating $941 million to the Health Care Fraud and Abuse Control (HCFAC) program, a $48 million increase from FY 2023 (p. 4). These funds will be used for:
- Predictive Analytics: Advanced predictive analytics will identify suspicious billing patterns in Medicare and Medicaid, leading to quicker fraud detection.
- Provider Enrollment Integrity: A new system will streamline and verify provider enrollment, enhancing program integrity (p. 75).
- Areas with Significant Funding Increases
- Survey and Certification Program
The Survey and Certification Program will receive $492.3 million, an increase of $85 million from FY 2023 (p. 15). This funding will strengthen oversight of healthcare facilities and ensure compliance with federal quality and safety standards.
Federal Marketplaces
Federal Marketplaces will receive significant funding to enhance the consumer experience and program integrity:
- State-based Marketplaces (SBMs): CMS will work with SBMs to ensure seamless data integration with Federal Marketplaces and improve eligibility verification processes.
- Health Equity Initiatives: Investments in health equity will expand access to underserved populations, addressing disparities in care.
Medicare Advantage and Part D Modernization
Modernizing Medicare Advantage (MA) and Part D programs is a priority. Increased funds will be used to:
- Implement New Payment Models: Innovative payment models will incentivize value-based care and improved health outcomes.
- Digital Quality Measurement: CMS will expand the use of digital quality measures to assess and improve care delivery.
Conclusion
In FY 2025, CMS is making transformative investments in technology and modernization, aiming to improve healthcare delivery, program integrity, and beneficiary experience. By prioritizing IT infrastructure, cybersecurity, and program integrity, CMS is poised to deliver more efficient, effective, and equitable healthcare services in the years ahead.
For more detailed information, the full document can be accessed here. Specific sections include:
- IT Modernization: p. 185
- Survey & Certification: p. 73
- HCFAC Funding: p. 123
- Program Integrity Measures: p. 228
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