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Chiquita Brooks-LaSure, CMS Head, Vows To Improve Access To Health Care

 
 

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Lasure makes it clear her primary objectives is more Medicaid.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Chiquita Brooks-LaSure, sworn in last week as the administrator of the Centers for Medicare & Medicaid Services, says she will focus on improving Americans’ access to health care. Any discussions of shoring up Medicare funding, she says, should also entail strengthening the program’s benefits. Caroline Brehman/CQ-Roll Call Inc. via Getty Images hide caption

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Caroline Brehman/CQ-Roll Call Inc. via Getty Images

Chiquita Brooks-LaSure, sworn in last week as the administrator of the Centers for Medicare & Medicaid Services, says she will focus on improving Americans’ access to health care. Any discussions of shoring up Medicare funding, she says, should also entail strengthening the program’s benefits.

Caroline Brehman/CQ-Roll Call Inc. via Getty Images

The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity.

“We’ve seen through the pandemic what happens when people don’t have health insurance and how important it is,” said Chiquita Brooks-LaSure, who was confirmed by the Senate to lead the Centers for Medicare & Medicaid Services on May 25 and sworn in on May 27. “Our focus is going to be on making sure regulations and policies are going to be focused on improving coverage.”

That approach is an abrupt switch from the Trump administration, which pushed the agency to do what it could to help repeal the Affordable Care Act and scale back the Medicaid program, the federal-state program for people with low incomes.

Brooks-LaSure, whose agency oversees the ACA marketplaces in addition to Medicare, Medicaid and the Children’s Health Insurance Program, said she is not surprised at the robust increase in the number of people enrolling in ACA insurance since President Biden reopened enrollment in January. As of last month, the administration says, more than 1 million people had signed up.

“Over the last couple of years, I’ve worked with a lot of the state-based marketplaces and we could see the difference in enrollment when the states were actively pushing coverage,” Brooks-LaSure said. A former congressional and Obama administration health staffer, she most recently worked as managing director at the consulting firm Manatt Health. “I believe that most people who are not enrolled want coverage” but may not understand it’s available or how to get it, she said. “It’s about knowledge and affordability.”

Brooks-LaSure also suggested that the Biden administration would support efforts in Congress to ensure coverage for the millions of Americans who fall into what’s come to be called the Medicaid gap. Those are people in the dozen states that have not expanded Medicaid under the Affordable Care Act who earn too little to qualify for ACA marketplace coverage. Georgia Democratic Sens. Jon Ossoff and Raphael Warnock, whose GOP-led state has not expanded the program, are calling for a new federal program to cover people who fall into that category.

Brooks-LaSure said she would prefer that states use the additional incentive funding provided in the recent American Rescue Plan toward expanding their Medicaid programs “because, ideally, states are able to craft policies in their own states; they’re closest to the ground.” But if states fail to expand Medicaid (none has taken up the offer in the new provision so far), “the public option or other coverage certainly would be a strategy to make sure people in those states have coverage,” she said.

Also on her radar is the need to deal with the impending insolvency of the trust fund that finances a large part of the Medicare program. Last year’s economic downturn — and the resulting drop in tax revenue from employees’ paycheck withholdings — is likely to accelerate the date when Medicare’s hospital insurance program will not be able to cover all of its bills.

Brooks-LaSure said she is sure she and Congress will be spending time on the issue in the coming year, but those discussions could also provide an opportunity for officials to reenvision the Medicare program and consider expanding benefits. Democrats in Congress are looking at both lowering Medicare’s eligibility age and adding benefits the program now lacks, including dental, hearing and vision coverage.

“I hope that we, when we are looking at solvency, really focus on making sure we keep the Medicare program robust,” said Brooks-LaSure. “And that may mean some changes that strengthen the program.”

Kaiser Health News is a national, editorially independent newsroom and program of Kaiser Family Foundation and is not affiliated with Kaiser Permanente.

 
 

Clipped from: https://www.npr.org/sections/health-shots/2021/06/03/1002709898/expanding-health-coverage-is-top-priority-for-new-head-of-medicare-medicaid

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CMS Proposes Delays to Major Regulations Affecting Medicaid Rebates

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CMS is delaying rollout of value based rx arrangement to give itself and states more time to implement required data collection systems.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

On May 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule to delay the effective dates of two amendments to the Medicaid Drug Rebate Program (MDRP) related to manufacturer reporting of multiple best prices for drugs when offered as part of a value-based purchasing (VBP) arrangement and inclusion of U.S. territories in the MDRP. CMS is requesting public comment on the proposed effective date delays by June 28, 2021.

Delay of Effective Date for Reporting Multiple Best Prices for VBP Arrangements

CMS proposes to delay for six months the January 1, 2022 effective date for the provisions addressing manufacturer reporting of multiple best prices connected to a VBP arrangement. CMS’ primary stated reason for the proposed delay is to provide more time for CMS, states, and manufacturers to make the complex system changes necessary to implement the new best price and VBP program and assure patient access and quality of care, given the current need to devote resources to the public health emergency (PHE) relating to COVID-19 and the significant expansion of Medicaid under the American Rescue Plan Act of 2021 (ARP).

In proposing this delay, CMS acknowledges that it needs more time to ensure that its own technology infrastructure will be ready to receive multiple best prices related to VBP arrangements. CMS is developing a new Medicaid Drug Program (MDP) system to replace its current system but does not believe it will be ready by January 1, 2022 to operationalize the VBP program.

In addition, CMS stated that State Medicaid agencies need more time to develop capabilities and build an infrastructure that will be able to implement VBP arrangements. Specifically, State Medicaid agencies must develop and implement systems and methods to track beneficiaries and their outcomes, retrieve and evaluate the patient-specific outcomes data, and secure the cooperation of providers and beneficiaries to enter into some of the more complex outcome-based arrangements offered by pharmaceutical manufacturers. CMS stated, without citing evidence, that a reason for the delay was that manufacturer resources were likely diverted away from the implementation of VBP arrangements due to researching, producing, and distributing COVID-19 drugs and vaccines. Some stakeholders were puzzled by this explanation, however, as VBP arrangements continue to be actively pursued, and no manufacturer has publicly called for a delay in implementation of this provision.

Accordingly, CMS believes that July 1, 2022 is a more realistic target date for implementation of the VBP multiple best price program. CMS also stated that it expects to issue additional guidance before July 1, 2022 on operational and policy aspects of the new VBP program, including specifications relating to beneficiary protections.

Delay of Inclusion Date for U.S. Territories in the MDRP

CMS also proposes to delay the April 1, 2022 effective date of inclusion for U.S. territories (American Samoa, Northern Mariana Islands, Guam, Puerto Rico, and the Virgin Islands) in the definitions of “States” and “United States” for purposes of the MDRP to April 1, 2024. However, if public comments indicate readiness to include territories in the MDRP, CMS proposes to finalize an inclusion date that may be earlier than April 1, 2024, but not before January 1, 2023.

The MDRP regulatory definitions of “States” and “United States” were originally amended to include the U.S. territories by the Covered Outpatient Drug Final Rule (February 1, 2016), with a delayed inclusion date of April 1, 2017. Subsequently, CMS issued two interim final rules to further delay the inclusion date for the U.S. territories in the regulatory definitions of ”States” and ”United States” to April 1, 2022 based on discussions with the territories on preparedness to join the MDRP and concerns related to manufacturers potentially increasing drug prices to avoid setting new Medicaid best prices.

CMS is again proposing to delay the inclusion date of U.S. territories in the MDRP for substantially the same reasons, namely that territory resources should prioritize demands arising from the PHE and expansion of Medicaid under ARP to address beneficiary needs during COVID-19.

 
 

Clipped from: https://www.lexology.com/library/detail.aspx?g=0e6295c3-87b2-4b31-808c-45b32e29c521

 
 

 
 

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Senate confirms Chiquita Brooks-LaSure as head of CMS

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CMS now has an administrator.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Phil Roeder, Flickr

Dive Brief:

  • The Senate has confirmed health policy veteran Chiquita Brooks-LaSure as the Biden administration’s head of CMS, following a drawn-out approval process. As CMS administrator, Brooks-LaSure will have extensive oversight over the massive Medicare and Medicaid insurance programs and the exchanges set up by the Affordable Care Act.
  • The body voted 55-44 to confirm the nominee Tuesday morning. A majority of the Senate on Monday voted to limit debate on her nomination, queuing up Tuesday’s final vote. Brooks-LaSure’s nomination was earlier held up by Senate Republicans over an unrelated Biden administration policy move to rescind a Texas Medicaid waiver.
  • Industry groups including the Federation of American Hospitals and the Surgical Care Coalition cheered her confirmation, saying Brooks-LaSure’s policy know-how and experience managing insurance programs should help increase equitable access to affordable care in the U.S.

Dive Insight:

Brooks-LaSure has a long career in public policy, working in the Office of Management and Budget as a Medicaid analyst before moving on to serve as deputy director for policy at the Center for Consumer Information and Insurance Oversight during the Obama administration. She was also a director of coverage policy at HHS before transitioning to the private sector, working as a Medicare and Medicaid policy consultant for Manatt Health.

With Tuesdays vote, Brooks-LaSure becomes the first Black woman to lead CMS.

Despite general support for the health policy veteran in Congress and a lack of any partisan fireworks during her hearings, Brooks-LaSure’s confirmation process has been slow.

In April, Republicans in the Senate Finance Committee held up the process not due to Brooks-LaSure’s record or experience, but due to HHS’ withdrawal of a Medicaid waiver to Texas that had previously been approved by the Trump administration. The waiver would have given the state more than $100 billion over a decade in federal funding and allowed more flexibility in how it structures the safety-net insurance scheme.

Its withdrawal caused Sen. John Cornyn, R-Texas, to say he would delay the confirmation. Cornyn said losing the waiver would threaten vulnerable Texans’ access to care by winnowing hospital funding, though progressives generally view the waivers as a stop-gap measure that doesn’t address fundamental issues with medical access and curbing downstream costs.

Eventually, the committee voted 14-14 along party lines to move the nomination to the full Senate floor, without a recommendation for confirmation.

And on May 12, the full Senate once again advanced Brooks-LaSure’s nomination, in a 51-48 procedural vote. Senate Democrats were joined by two Republican legislators in backing a discharge petition to bring her nomination to a floor vote after it was held up by the finance committee and GOP opposition to her confirmation.

Hospital and payer groups, progressive think tanks and patient advocates were pleased with the confirmation on Tuesday.

Many noted that Brooks-LaSure’s experience in health policy, especially with the ACA and Medicaid, should help expand access to low-cost care as medical prices continue to rise in the U.S.

“We congratulate Ms. Brooks-LaSure on her historic confirmation,” FAH President and CEO Chip Kahn said in a statement. “While the fight against COVID is not over, as the pandemic winds down we need to move forward on the broader health care agenda and I am confident our new Administrator is exceptionally equipped to provide the leadership that is crucial for CMS at this time and beyond.”

Brooks-LaSure is the last major health policy appointment from the Biden administration. Previously, HHS Secretary Xavier Becerra faced grilling from Republicans over his abortion views, but was approved by a single-vote margin; while HHS deputy secretary Andrea Palm was confirmed in a 61-37 vote earlier this month.

But, four months into his administration, President Joe Biden still has not nominated anyone to fill the top spot at the Food and Drug Administration, a crucial post with oversight over drugs and vaccines, but also major public health issues like food safety and tobacco.

 
 

Clipped from: https://www.healthcaredive.com/news/senate-confirms-chiquita-brooks-lasure-as-head-of-cms/600302/

 
 

 
 

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CMS issues guidance for state Medicaid SDOH programs

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CMS guidance on priority focus areas for SDH efforts in Medicaid is now out.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

CMS issued a new guidance for state officials looking to roll out social determinants of health strategies for Medicaid and Children’s Health Insurance Program members.

The guidance, released Jan. 7, focuses on how state Medicaid directors can use flexibilities under federal law to design programs that decrease healthcare spending and improve outcomes through addressing social, environmental and economic factors.

CMS’ guidance focuses on housing projects, nonmedical transportation, meal delivery, education and employment support, among others. 

View the full guidance here.



Clipped from: https://www.beckershospitalreview.com/payer-issues/cms-issues-guidance-for-state-medicaid-sdoh-programs.html


 

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HHS Proposes New Prior Authorization Rules for Medicaid, CHIP and Certain Marketplace Plans – Manatt, Phelps & Phillips, LLP

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A new federal DHS rule will require payers to implement technology that reduces complexity and delays associated with prior authorizations in Medicaid, CHIP and exchange coverage. This rule also would add new requirements and clarifications related to the Interoperability Rule finalized in May 2020.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

 
 

Clipped from: https://www.manatt.com/insights/newsletters/manatt-on-health/hhs-proposes-new-prior-authorization-rules-for-med

 
 

On December 10, the U.S. Department of Health & Human Services (HHS) released a Proposed Rule with the goal of “making the prior authorization process less burdensome for payers and providers, and in turn, avoiding care delays for patients.” In addition, HHS proposes to build on the Interoperability Rule released in May 2020 by significantly expanding the circumstances under which healthcare payers must make data available in a standardized fashion via Application Programming Interfaces (APIs). (See here for Manatt’s June 2020 white paper on consumer digital health privacy, which addresses these API requirements and other issues.)

The Proposed Rule would apply to the following “impacted payers”:

  • Medicaid and CHIP programs, including both fee-for-service programs and managed care plans.
  • Qualified health plans offered on the Federally Facilitated Exchanges (FFE QHPs). Unlike the Interoperability Rule, the Proposed Rule would not affect Medicare Advantage plans or commercial plans offered on State-Based Exchanges.

If finalized, the Proposed Rule would take effect in 2023, and could require impacted payers to make significant updates to their existing technology and prior authorization procedures.

HHS has solicited public comments on all aspects of the Proposed Rule, and also on a variety of other issues related to prior authorization procedures. Comments are due by January 4, 2021. This timeline is significantly shorter than is typical for proposed rules, and suggests that the Trump Administration may be hoping to finalize the rule before President Trump leaves office.

What Are the Proposed Rules Regarding Prior Authorization?

If finalized as proposed, the following requirements would apply starting in 2023 with respect to prior authorization procedures for all services except prescription drugs. HHS has proposed to allow exemptions or extensions, however, for impacted payers that meet certain requirements.

  • Electronic requests and responses. Medicaid, CHIP and FFE QHPs would be required to implement APIs that: (1) allow providers to identify in advance each payer’s prior authorization requirements, including the list of services that require prior authorization and the documentation needed to request it; and (2) offer a HIPAA-compliant mechanism for providers to electronically send prior authorization requests and receive responses through the provider’s electronic health record (EHR) platform.
  • Tighter time frames. Medicaid and CHIP (but not FFE QHPs) would be subject to stricter time frames for responding to prior authorization requests. Specifically, Medicaid and CHIP payers would be required to provide notice of prior authorization decisions:
     

 
 

  • For expedited decisions, no later than 72 hours after receiving a request (consistent with existing standards for Medicaid managed care and CHIP);
  • For standard decisions, no later than seven days after receiving a request (down from the current limit of 14 days in Medicaid managed care and CHIP).
  • Reasons for denials. When denying prior authorization, Medicaid, CHIP and FFE QHPs would be required to provide a specific reason for the denial (e.g., a determination that necessary documents were missing, the service was not medically necessary or the patient has exceeded applicable service limits).
  • Increased transparency.
     

 
 

  • Information on pending and approved prior authorization requests would need to be made available to patients and providers through the Patient and Provider Access APIs (described below).
  • Impacted payers would be required to publish certain prior authorization data, including the list of services that are subject to prior authorization, the payer’s average and median response times for prior authorization requests, and the percentage of requests that were denied or approved, as well as information on appeals and extensions of time.

How Does the Proposed Rule Interact With the May 2020 Interoperability Rule?

  • Enhanced Requirements for the Patient Access API. The Interoperability Rule requires payers to make various types of clinical, claims and encounter data available to patients through a “Patient Access API.” The Proposed Rule would add new requirements for these Patient Access APIs, which are generally consistent with HHS’s existing guidance regarding API development and procedures for vetting the security of third-party apps that patients might use to access their data. In addition, the rule would require impacted payers to report quarterly on certain metrics regarding API data requests.
  • Two New APIs for Data Exchange. Over and above the Patient Access API, HHS proposes to require that Medicaid, CHIP and FFE QHPs implement a Payer-to-Payer API to facilitate data transfers when a patient switches payers, and a Provider Access API that allows providers to access data on their patients in real time.

Conclusion

HHS is proposing to enhance the ability for patients and providers to access payer-held data and to communicate with payers about prior authorization. These proposals would, however, require new compliance activities for Medicaid and CHIP programs as well as commercial plans offered on the Federally Facilitated Exchanges. Stakeholders interested in expressing their views on these proposals should be sure to submit their comments before the January 4, 2021 deadline.