Centers for Medicare & Medicaid Services
Decarbonization and Resilience Initiative
Section 1115A(b)(4)(B) of the Social Security Act (42 U.S.C. 1315a(b)(4)(B)) establishes the Center for Medicare and Medicaid Innovation, and the cited subsections grant discretion to collect data necessary for the purposes of evaluating and monitoring its models. Given that “[o]verwhelming evidence points to GHG emission's deleterious effect on patient health and the disproportionate impact born by Medicare, Medicaid, and [Children's Health Insurance Program] beneficiaries,” CMS has determined that this provision requires it to “collect data on GHG emissions, through voluntary reporting, as part of our monitoring and evaluation of the model, just as CMS monitors for other quality indicators that may impact beneficiary health.”
On August 28, 2024, the Centers for Medicare & Medicaid Services (CMS) adopted a final rule that created a new mandatory alternative payment model called the Transforming Episode Accountability Model (TEAM). (89 Fed. Reg. 68986, Aug. 28, 2024). The final rule included a voluntary Decarbonization and Resilience Initiative within TEAM to assist hospitals in addressing the threats to the nation’s health and its health care system presented by climate change and the effects of hospital carbon emissions on health outcomes, health care costs and quality of care. The voluntary initiative has two elements: (1) technical assistance for all interested TEAM participants and (2) a voluntary reporting option to capture information related to Scope 1 and Scope 2 emissions as defined by the Greenhouse Gas Protocol framework, with the potential to add Scope 3 in future years. The start date for the initiative is January 1, 2026.
Biden Administration (2021-2025)
Regulation Strengthening the Resilience of Medical Supply Chains
On August 28, 2024, the Centers for Medicare & Medicaid Services (CMS) adopted a final rule that created a new mandatory alternative payment model called the Transforming Episode Accountability Model (TEAM). (89 Fed. Reg. 68986, Aug. 28, 2024). The final rule included a voluntary Decarbonization and Resilience Initiative within TEAM to assist hospitals in addressing the threats to the nation’s health and its health care system presented by climate change and the effects of hospital carbon emissions on health outcomes, health care costs and quality of care. The voluntary initiative has two elements: (1) technical assistance for all interested TEAM participants and (2) a voluntary reporting option to capture information related to Scope 1 and Scope 2 emissions as defined by the Greenhouse Gas Protocol framework, with the potential to add Scope 3 in future years. The start date for the initiative is January 1, 2026.
- Final Rule (89 Fed. Reg. 68986, Aug. 28, 2024)
- Proposed Rule (89 Fed. Reg. 35934, May 2, 2024)
Health System Climate Change Efforts
On August 10, 2022, CMS issued a final rule dealing with various Medicare payment rates and systems. (87 Fed. Reg. 48780, Aug. 10, 2022). The final rule also discussed feedback CMS received in response to requests for information on how hospitals, nursing homes, hospices, home health agencies, and other providers can better prepare for the harmful impacts of climate change on their patients, and how CMS can support them in doing so. CMS reported that many commenters underscored the impacts of climate change, particularly on specific disease and service lines, as well as on underserved populations, and that many commenters provided sources of public data and analyses that depict healthcare’s impact on climate. CMS said commenters almost uniformly embraced the importance of setting goals for reduced emissions and increased climate resilience but requested specific types of information, assistance, updates to requirements, and attention to challenges such as strains on providers and engagement with supply chain stakeholders. CMS said it would consider the feedback and continue to engage all interested parties via multiple avenues including future notice-and-comment rulemaking.
Biden Administration (2021-2025)
Final Regulation on Medicare Payment System Receives Extensive Climate Change Concern
On August 10, 2022, CMS issued a final rule dealing with various Medicare payment rates and systems. (87 Fed. Reg. 48780, Aug. 10, 2022). The final rule also discussed feedback CMS received in response to requests for information on how hospitals, nursing homes, hospices, home health agencies, and other providers can better prepare for the harmful impacts of climate change on their patients, and how CMS can support them in doing so. CMS reported that many commenters underscored the impacts of climate change, particularly on specific disease and service lines, as well as on underserved populations, and that many commenters provided sources of public data and analyses that depict healthcare’s impact on climate. CMS said commenters almost uniformly embraced the importance of setting goals for reduced emissions and increased climate resilience but requested specific types of information, assistance, updates to requirements, and attention to challenges such as strains on providers and engagement with supply chain stakeholders. CMS said it would consider the feedback and continue to engage all interested parties via multiple avenues including future notice-and-comment rulemaking.
Request for Information on Hospital Preparation for Climate Impacts
On May 10, 2022, CMS issued a proposed rule that included a request for information on how hospitals, nursing homes, hospices, home health agencies, and other providers can better prepare for the harmful impacts of climate change on their patients, and how CMS could support them in doing so. (87 Fed. Reg. 28108, May 10, 2022).