Top priorities for CMS include Stark law, ACA mandate changes
CMS Administrator Seema Verma, MPH, offered some hints at the agency’s priorities in its annual rulemaking for Medicare this year, suggesting a slew of new policies on price transparency, interoperability and physician self-referral laws.
Known as the Stark law, the statutes prohibit physicians from referring Medicare or Medicaid beneficiaries to entities from which the physician or an immediate family member would financially benefit. In transitioning from volume to value in Medicare, however, Verma said doctors see it as an impediment.
"We've heard that that's a big barrier for providers when they're trying to do value-based payment arrangements," she said, according to POLITICO’s Pulse newsletter.
Verma said the industry can expect “actual actions” this year on the recently announced MyHealthEData initiative aimed at expanding interoperability and patients’ access to their own data. The agency will also push for greater price transparency efforts to let beneficiaries compare the price of services between providers.
Those changes could be included in a number of the payment rules CMS releases every year. Proposed 2019 rates for hospital inpatient services, skilled nursing and rehab facilities will likely be released in April, while the annual prospective payment rules for physicians and outpatient services usually come out in June.
Beyond those payment rules, Verma said CMS is considering additional actions on the ACA. While HHS has already sought to expand non-ACA-compliant insurance options, customers who don’t buy compliant coverage—or go uninsured entirely—would still be subject to the individual mandate penalty this year, as its elimination in the Republican tax cut law won’t go into effect until 2019. Verma said CMS is considering how it can offer additional exemptions from the penalty.
“I can't comment on the timeline but that is something that we are giving a lot of consideration to,” Verma said, according to the Washington Examiner.
On other policy possibilities, Verma was noncommittal, such as when she declined to say whether CMS would approve states’ requests to impose lifetime limits in Medicaid. Inside Health Policy reported she would only say Medicaid waivers have to ““meet the objectives of the Medicaid program.” Five states—Arizona, Kansas, Maine, Utah and Wisconsin—have proposed through Section 1115 waiver limiting the number of years some Medicaid beneficiaries can receive coverage through the program.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.