December 3, 2021

Volume XI, Number 337

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McDermottPlus Check-Up: October 22, 2021

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.

© 2021 McDermott Will & EmeryNational Law Review, Volume XI, Number 295
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About this Author

Aaron Badida Healthcare Attorney McDermott

Aaron leverages a health-focused legal background with research and writing expertise to help clients analyze the impact of, and respond to, pending regulatory and legislative actions.

Aaron works with clients to provide data-driven insights to inform stakeholder comments on proposed regulations and tracks regulatory developments to ensure clients are engaged and informed on the policy matters that impact their businesses. He is also experienced in assessing Medicare payment regulations, as well as regulations from the Centers for Medicare & Medicaid Services, the Centers for...

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Debra Curtis Health Policy Attorney Congress McDermott Will Emery

Debbie is a highly respected health policy authority who helps clients advance their missions in Congress and beyond. With more than three decades of experience working both on the Hill and with the health insurance exchange marketplace, she helps clients execute payment strategy, see around the corner on policy and regulatory changes, and pursue effective advocacy. In addition, Debbie has deep experience working closely with payers, industry stakeholders and government officials at the federal, state and local levels.

During her 24 years as a...

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Kristen O’Brien Healthcare Executive McDermott Consulting
Execusitve

Kristen O’Brien is an accomplished healthcare executive with a deep understanding of regulatory advocacy and healthcare policy efforts.

Kristen offers a strong background and a keen eye for solutions to barriers and challenges impacting healthcare clients. With more than 10 years of experience, her work focuses on implementing new laws through the rulemaking process, as well as working with relevant agency officials to develop and improve agency guidance.

Kristen recently served as Principal of the Health Industry Policy and Regulatory Practice Group at a law and lobbying...

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Professional Advisor

Erica Stocker is a professional advisor in the law firm of McDermott Will & Emery LLP and is based in the Firm’s Washington, D.C., office. Erica focuses primarily on health care, including provider reimbursements, quality of care and patient safety.

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Katie Waldo Healthcare Attorney

Katie is an experienced government relations strategist who helps clients navigate the complex issues surrounding Medicare, Medicaid and the healthcare marketplace.

Katie works with clients to represent their needs before the US Congress and the US Department of Health and Human Services (HHS) and its agencies by relying on extensive experience as a policy advisor on the Medicaid and Medicare programs, as well as the 340B program and other aspects of the Public Health Service Act. She anticipates the effects of state and federal policymaking on issues impacting their businesses and...

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