HealthCare Roundtable e-News – June 8, 2021

Bipartisan U.S. House Members to CMMI Director: Be More Transparent in Model Development and Implementation

Lawmakers on both sides of the aisle have expressed concerns recently over the lack of transparency coming out of the Center for Medicare and Medicaid Innovation around the agency’s authority and obligations. A letter, drafted by 26 House lawmakers led by Reps. Terri Sewell (D-Ala.) and Adrian Smith (R-NE), cited the scope and duration of demonstration projects and the transparency of the center’s actions and decision-making as a few of their primary concerns.

“We believe that CMMI could strengthen its model development by allowing more stakeholder engagement. Further, Congress and the public need to know how results will be sampled and evaluated and which beneficiaries stand to be affected,” the letter stated.

CMMI Director Liz Fowler received the letter prior to last week’s Health Affairs conference, where the director acknowledged that there have been “misgivings” about the agency not checking back with lawmakers and making sure that their agenda “is in line with what legislators are thinking.” (InsideHealthPolicy)

Director Fowler also suggested during the Health Affairs conference that lawmakers should expect more mandatory, value-based care payment models in the near future. In an interview with Health Affairs Editor-in-Chief Alan Weil, Fowler commented that what the agency “has learned from CMMI models over the past 10 years is that voluntary models [are] subject to risk selection, which has a negative impact on the ability to generate system-level savings.” According to Fowler, the preferred direction is to focus more on the patient than the provider through value-based models.

Fowler was also asked at the conference whether she has a legislative agenda that could “make things easier for the innovation center,” to which she responded that her ideas needed to be shared with newly confirmed CMS Administrator Chiquita Brooks-LaSure before sharing them with the public. (InsideHealthPolicy)

Stakeholders Ask HHS to Allow Audio-Only Telehealth in MA Risk Adjustment

Last Thursday (June 3), a group of 20 health care and insurance plan organizations, including Alliance of Community Health Plans, AHIP, and LeadingAge, penned a letter to HHS leadership requesting the agency allow Medicare Advantage plans to submit diagnoses from audio-only telehealth appointments for risk adjustment. The letter, which was addressed to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure, claims that the exclusion of audio-only encounters factoring into MA risk adjustment furthers health disparities for vulnerable populations. (InsideHealthPolicy)

“Not allowing the health status of seniors who have utilized audio-only services for risk-adjustment provides an incomplete picture of the health of the Medicare population and unintentionally makes seniors appear healthier than they are,” the groups argued. According to CMS data from last summer during the pandemic, 40% of MA enrollees earned less than $25,000 annually, and of those, 35% did not have access to broadband internet in their homes, making audio-only telehealth even more of an essential service.

However, not all consumer advocates agree that allowing audio-only services in MA risk adjustment is a positive advancement for beneficiaries. One consumer advocacy organization told Inside Health Policy that they did not support the proposal, “in part, due to high profits earned by health insurers last year during the pandemic and CMS’ decision to already significantly boost MA payment for 2022. Plans should be able to justify diagnoses with more than just a phone call.”

Several bipartisan bills have been introduced this year by lawmakers aiming to allow MA risk-adjustment to incorporate audio-only services during plan years 2020 and 2021, including a House bill led by Reps. Tony Cárdenas (D-Calif.), Rep. Terri Sewell (D-Ala.), Rep. Gus Bilirakis (R-Fla.), Brian Fitzpatrick (R-Pa.), Chrissy Houlahan (D-Pa.), Ron Kind (D-Wis.), Jason Smith (R-Mo.), and Jackie Walorski (R-Ind.) to expand service for seniors beyond the pandemic.

AARP to Congress: Fix Long-Term Care in the U.S.

During a public roundtable last week, AARP leaders discussed the growing need for home-based, long-term health care solutions, with the pandemic having been the primary catalyst for policy reform. AARP Executive Vice President and Chief Advocacy & Engagement Officer Nancy LeaMond spoke on the topic, citing that the pandemic exposed the “inadequacy of America’s long-term health system.”

“The home is the new health care center. Make no mistake about it. People are not anxious to go to nursing homes – they want to stay in their homes,” she said. “We know that there’s going to be a debate on Capitol Hill, as we move through this year, and it’s important – we always talk to ourselves about how we need to focus less on the how, whether it’s reconciliation or some other method, and more on what needs to be done.”

President Joe Biden recently proposed investing $400 billion in Medicaid home- and community-based care through the upcoming infrastructure package, but indicated that he does not plan to compromise on the inclusion of HCBS. However, Republican senators have not shown any interest in human infrastructure in the legislative package, indicating that Democrats will likely use reconciliation to pass infrastructure legislation.

LeaMond has indicated that AARP would support other policies that invest in home care workers, including family caregivers, like the Credits for Caregivers Act, which would provide federal tax credits for people who provide long-term care to family members. (InsideHealthPolicy)

White House Unveils Plans to Share 25M Vaccine Doses With COVAX, 80M Total

The White House announced last week that it plans to share 80 million COVID-19 vaccine doses with other countries all over the world, the initial 25 million of which will go to the World Health Organization’s COVAX initiative. The vaccine shipments will include doses of FDA-approved Pfizer, Moderna, and Johnson & Johnson, with doses to be distributed by the end of June.

Of the first 19 million donated through COVAX, approximately 6 million doses will go to South and Central America, 7 million to Asia and 5 million to Africa. According to U.S. National Security Adviser Jake Sullivan, the U.S. “will retain the say” on where doses distributed through COVAX ultimately go. White House officials have also commented that the United States will share vaccine doses with regions and countries in crisis, including South Korea and the West Bank and Gaza. (InsideHealthPolicy)

“We are sharing these doses not to secure favors or extract concessions,” Biden said. “We are sharing these vaccines to save lives and to lead the world in bringing an end to the pandemic, with the power of our example and with our values.”

White House COVID-19 response coordinator Jeff Zients confirmed that the United States also has plans to work with global democracies to coordinate a multilateral effort, including through the G7, to combat and end the pandemic. More details will be shared at the G7 summit to be held in the United Kingdom June 11 through June 13, according to Sullivan.

A White House fact sheet covering the administration’s vaccine sharing plans can be found here.