Two Congressional leaders, U.S. Representative Richard Neal (D-MA), chairman of the House Committee on Ways and Means, and Rep. Kevin Brady (R-Texas), ranking member of the committee, are calling for greater transparency from the Center for Medicare and Medicaid Innovation (CMMI) as it develops new delivery and payment models, and are urging agency leaders to reform their processes to enable more input from industry stakeholders.
CMMI was created by the Obama Administration and is charged with piloting, testing and evaluating alternative payment models. In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, Neal and Brady note that Congress established CMMI “to test different innovative delivery system and payment models to improve quality and reduce costs for Medicare and Medicaid beneficiaries.”
“In carrying out its duties, CMMI is required to ‘consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The [CMMI] shall use open door forums or other mechanisms to seek input form interested parties’,” the lawmakers wrote in the letter, citing the federal code that established CMMI.
“We’ve long been advocates for health care innovation,” Neal and Brady wrote in the letter to Verma. “However, significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the health care community. We strongly urge the Agency to provide more sunshine in this process, and allow Congress, beneficiaries, and stakeholders greater opportunity to provide feedback into the policies that CMMI tests that affect millions of Americans with Medicare.”
CMMI has been notably quiet in the first two years of the Trump Administration. Adam Boehler, the former CEO of home-based care startup Landmark Health, was named CMMI Director back in April.
Many industry stakeholders have been waiting to see what CMMI has in store for this year. In a tweet posted Thursday, Anders Gilberg, senior vice president, government affairs for the Medical Group Management Association (MGMA), welcomed the lawmakers’ efforts to encourage more transparency from CMMI and CMS officials. “Medicare payment model development has been both opaque and anemic. Medical practices need new non-mandatory APMS (alternative payment models) in 2019,” Gilberg tweeted.
In the letter to Verma, Neal and Brady noted that the CMMI model development process “has historically been opaque to Congress and to stakeholders.” “CMMI does not always use the traditional rulemaking cycle in which the public may provide comment to CMS to better inform and perfect the regulatory process. Moreover, over the last few years, CMMI rulemaking has been narrowed to topics that only include mandatory models, rather than an opportunity to better understand how all models would affect patients and the Medicare program.”
Congress allows the U.S. Department of Health and Human Services (HHS) Secretary to waive certain Medicare rules, so long as the model is expected to improve quality and reduce spending or reduce spending without reducing quality, the two lawmakers noted in the letter, which is why “it is imperative to have a transparency, public process to ensure that these models do not cause unintentional harm to Medicare beneficiaries.”
Neal and Brady urged Administrator Verma to promptly inform Congress as to what models are under active consideration by CMMI. They noted that they have heard from stakeholders that some models currently may be in development.
The lawmakers specifically called for Verma to provide an estimated timeline for any model under development at CMMI, the rulemaking or other public comment period that will be provided before finalization of the model parameters and the Innovation Center Investment Proposals (ICIPs) for these models.
Additionally, Neal and Brady are calling on Verma to provide detail on how CMMI has fulfilled its statutory obligation to “consult with representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management.”
The lawmakers also want estimates from the Office of the Actuary as it relates to models currently under development. And, the lawmakers want further assurances of how CMS and CMMI intends to promote transparency and engage Congress, industry stakeholders, Medicare beneficiaries and the public prior to any model being finalized.
The lawmakers requested CMS and CMMI officials respond to their request for more information on CMMI models currently under development by January 23.
