McDermott+Consulting is pleased to provide the McDermottPlus Check-Up, your regular update on health care policy from Washington, DC.

This Week’s Dose

White House presses reconciliation talks forward. The Center for Medicare and Medicaid Innovation (CMMI) casts vision for next decade of value-based care. 

Congress

President and White House Officials Convened Members to Advance Reconciliation. Following weeks of impasse, the White House stepped in to move the Democratic majority’s reconciliation package forward in a series of meetings on Tuesday. The goal was to help reach an agreement on a framework of the reconciliation package before the end of the month. Initial reports are that the compromise will seek to keep as many health provisions as possible, but fund them for a shorter duration. Policies that may make  it in the final framework include: a three-year extension of the Affordable Care Act (ACA) advanced premium tax credits increases; a three-year ACA-style approach to establish a federal Medicaid option in states that have not yet expanded; and a too-be-determined amount of funding for home and community-based services.  Medicare dental, vision and hearing benefits have also been discussed, but it is possible that these benefits could be addressed through a voucher program outside of Medicare or drop out altogether.  Drug pricing reform, which would be used to offset the cost of other policies, remains in flux. As of this week, the topline number is still hovering around $2 trillion, but that figure remains uncertain until a final agreement is reached.  

Administration

CMMI Outlined Plans for Future of Value-Based Care. On Wednesday, the CMS Innovation Center held a special webinar to present its strategic plan  and release a new white paper, “Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade.” Center leadership stated that they will pursue a streamlined portfolio of models to reduce complexities and model overlap that have historically presented challenges and barriers to participation.  As part of its vision, leadership discussed making alternative payment models less burdensome to participate in while placing more emphasis on total cost of care approaches that focus on advanced primary care and accountable care organizations. The Center also wants to ensure that outcomes measures are meaningful to patients and that health equity and access to care are prioritized.

The strategic plan and the webinar were largely silent on specialty care models, including episodic and medical oncology models, but they did affirm CMMI’s intent to pursue models that align with the Department of Health and Human Service’s drug pricing plan. Examples of these include Part B models, shared savings models and bundled payments. CMMI is encouraging feedback and input on the new strategy from stakeholders and will be hosting a series of listening sessions, with the first to be held in November. 

Podcast

• Listen Here: On this week’s Breakroom, our resident regulatory experts Sheila Madhani and Deborah Godes discuss the forthcoming final rules for the Outpatient Hospital Prospective Payment System (OPPS) and Physician Fee Schedule.

Quick Hits

The U.S. Food and Drug Administration authorized booster shots of both the Moderna and Johnson & Johnson COVID-19 vaccine as well as “mixing and matching” booster doses.

Energy and Commerce Health Subcommittee Chair Rep. Anna Eshoo (D-CA) introduced a standalone piece of legislation to establish the Advanced Research Projects Agency for Health (ARPA-H), the cutting-edge medical research entity called for by President Biden.

The Health Resources and Services Administration issued an information collection request seeking comments on reporting requirements for the Provider Relief Fund.

Senator Patty Murray (D-WA) and Representative Frank Pallone (D-NJ) wrote a letter to the Departments of Labor, Treasury and Health and Human Services in support of the independent dispute resolution process outlined in the most recent regulation implementing the No Surprises Act, which addresses surprise medical billing.

The Biden Administration issued a fact sheet outlining its plan to facilitate vaccination of children ages 5-11 years old pending emergency use authorization for this population.

Senators Roger Marshall (R-KS), Kyrsten Sinema (D-AZ) and John Thune (R-SD) introduced the Improving Seniors’ Timely Access to Care Act aimed at reforming the use of prior authorization by Medicare Advantage plans.

CMS developed a website to facilitate information sharing and best practices for innovative home and community-based service models among State Medicaid Agencies. 

Next Week’s Diagnosis

There will be an Energy and Commerce legislative hearing on policies to support caregivers and patients. Education and Labor will hold a hearing on COVID-19 vaccination policies in the workplace. Veterans’ Affairs will examine patient safety.