At the agencies
The Centers for Medicare and Medicaid Services (CMS) made supportive statements about the Physician-Focused Payment Model Technical Advisory Committee (PTAC), an independent panel that advises the agency on alternative pay models critical to new Medicare physician pay schemes. CMS’s statement of support, which was embedded in a request for information (RFI) on reforming the agency’s Innovation Center, counters a comment from the Medicare Payment Advisory Commission (MedPAC) last month that suggested CMS should not rely on certain recommendations by PTAC. Congress created PTAC to allow stakeholders, including providers, to debate what should be considered alternative pay models under the Quality Payment Program (QPP). Providers are concerned about the definition of alternative payment models because Medicare pays bonuses to those who participate in the models, and participating providers will not be subject to the Merit-Based Incentive Payment System. Providers are encouraged by CMS’ comments in the RFI that requested information on pay models for specialty physicians, especially those in independent practices, with guiding principles in line with PTAC positions.
The Department of Veterans Affairs released a rule last week that allows VA telehealth providers to see any patient in their system regardless of state licensing constraints. The rule would reverse current requirements that patients be in a federal facility to use telemedicine services. The telehealth community has been awaiting the rule’s release since it was announced in August by President Trump and VA Secretary David Shulkin.
Brian LeClair was appointed as the new principal deputy administrator at the Health Resources and Services Administration (HRSA), the branch of HHS that focuses on providing care to underserved areas. He will serve under the HRSA Administrator George Sigounas. LeClair is a former Minnesota state senator, policy advisor to former Gov. Tim Pawlenty and president of LeClair Group, which trains health insurance agents.
On the Hill
The House Energy & Commerce Committee’s (E&C) reauthorization bill on the Children’s Health Insurance Program (CHIP) delays cuts to Medicaid Disproportionate Share Hospital (DSH) for one year. However, the cuts go back into effect for FY2019, and the delay would be paid for by cutting DSH funding by $16 billion in FY2026 and 2027. Current law cuts DSH payment this year, and cuts grow to $8 billion a year in 2024 and 2025. Under the E&C bill, cuts would begin in FY2019 at $3 billion and grow under the current schedule, plus the additional cuts in 2026 and 2027. The total reduction in DSH funding would increase from $35.1 billion to $43 billion under the bill. E&C this week declined to put the bill up for a full vote in the House, to provide more time for bipartisan talks on CHIP funding.
The Senate confirmed Eric Hargan as deputy secretary of HHS in a 57-38 vote, which included eight Democratic cross-overs. Given the departure of Tom Price, the president announced that Hargan will serve as acting secretary of the agency.
The Senate Budget Committee approved a FY2018 budget plan that would add $1.5 trillion to the deficit over the next 10 years as part of a tax code overhaul. The budget resolution includes a $695 billion defense budget after 10 years and steep spending cuts to domestic departments.
The committee approved an amendment that would allow the chairman to repeal the Independent Payment Advisory Board (IPAB). Sen. Cory Gardner (R-CO) offered the amendment as an alternative to a failed Democratic version that would have reversed Republican language allowing Congress to cut Medicare spending by almost $500 billion over 10 years. Republicans argue that the budget would not cut Medicare, but slow its rate of growth. The future of the amendment is uncertain, since it must still clear the Senate and then a House-Senate conference committee. The House Ways and Means bill also included language to repeal IPAB with bipartisan support. The budget resolution will likely be considered before the full Senate the week of Oct. 16.
Immediately after Republican leadership announced they would not vote on the Graham-Cassidy bill, the Senate unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. The bill would extend the Medicare Independence at Home demonstration for two years, permanently authorize Medicare Advantage special needs plans and expand coverage of telehealth services. Under the bill, CMS would assign beneficiaries to ACOs at the beginning of the year rather than retrospectively. Medicare would also pay for telestroke services and at-home kidney dialysis.
From the administration
White House Press Secretary Sarah Huckabee Sanders confirmed on Thursday night a decision by President Trump to stop cost sharing reduction (CSR) payments under the ACA. Because Congress has not appropriated funding for the program, payments, which are estimated at $7 billion this year, may end immediately. In her statement, Sanders called the payments unlawful and an insurance bailout. While the move will likely destabilize fragile Obamacare markets, the effect will be limited since many insurers had already factored a possible loss of the CSR payments into their 2018 rates. In the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee hearing on stabilizing individual healthcare markets, almost all of the committee members and panelists agreed on the importance of continuing the CSR payments. After repeated failures to repeal the ACA in Congress, the move is seen by many as an attempt to undermine the health law through executive action.
This week, President Trump signed an executive order that advises the Departments of Treasury, Labor and Health and Human Services to consider several rule changes to increase access to health insurance coverage that is not subject to a number of ACA requirements. Suggested changes include expanding access to association health plans (AHPs), expanding coverage through low-cost short-term limited duration insurance plans and changing Health Reimbursement Arrangements (HRAs) so employers can use them for additional healthcare expenses like deductibles and copayments. Since the executive order directs agencies to issue new regulations, the process will be subject to rulemaking procedures, and therefore will have little immediate effect.
President Trump reached out to Senate Minority Leader Chuck Schumer (D-NY) to work with Democrats on a “great Health Care Bill.” According to Schumer, Trump asked about another ACA repeal-and-replace, which Democrats would not approve. With the Democrats’ perception that the White House is trying to sabotage the law, there is little optimism for a bipartisan effort with the administration. The GOP is struggling with the future of the healthcare law after repeated failed attempts at repeal. Meanwhile, Trump has repeatedly criticized Congressional Republicans over their failed repeal efforts and sided with Democrats in the September debt limit deal.
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