President Issues Executive Order on Medicare
President Trump issued an Executive Order on Oct. 3rd requiring an array of "market-based" strategies in the Medicare program. Arguing that "Medicare for All" would reduce choices available to seniors, the Order seeks to expand Medicare Advantage (MA) choices and flexibility while aligning Medicare fee-for-service (FFS) rates with MA and commercial insurance payments. The scope and intent of these proposals remain unclear at this time. Among the directives set forth in the Order are the following:
- Promulgating regulations and taking administrative actions to encourage innovative MA benefit structures and plan designs, including Medicare Medical Savings Accounts, coverage of supplemental benefits and telehealth services, and supplemental MA benefits that allow Medicare beneficiaries to share more directly in savings.
- Requiring the Secretary of Health and Human Services and the Chairman of the Council of Economic Advisors to issue a report within 180 days that "identifies approaches to modify Medicare FFS payments to more closely reflect the prices paid for services in MA and the commercial insurance market, to encourage more robust price competition, and otherwise to inject market pricing into Medicare FFS reimbursement."
- Conducting a study that, within 180 days, recommends approaches to "transition toward true market-based pricing in the FFS Medicare program," including through shared savings and competitive bidding in FFS Medicare, the use of MA-negotiated rates to set FFS Medicare rates, and "novel approaches to information development and sharing that may enable markets to lower cost and improve quality for FFS Medicare beneficiaries."
- Proposing a regulation within one year to "provide beneficiaries with improved access to providers and plans by adjusting network adequacy requirements for MA plans to account for" factors such as the presence of certificate of need (CON) laws in states such as New York and access to telehealth and other technologies.
- Proposing a regulation within one year to enable providers to spend more time with patients by "eliminating burdensome regulatory billing requirements, conditions of participation, supervision requirements, benefit definitions, and all other licensure requirements of the Medicare program that are more stringent than applicable Federal or State laws require and that limit professionals from practicing at the top of their profession" and by reducing disparities in reimbursement between physicians and non-physician practitioners.
- Rewarding care through "site neutrality" measures that ensure that Medicare payments and policies "encourage competition and a diversity of sites for patients to access care."
- Making regulatory or sub-regulatory changes, to take effect by Jan. 1, 2021, to combat fraud, waste, and abuse in the Medicare program, including through the use of technologies such as artificial intelligence.
LeadingAge NY will be working closely with LeadingAge National to monitor developments under the Order and weigh in on issues that impact our members.
Contact: Karen Lipson, email@example.com, 518-867-8383 ext. 124