Executive Order Aims to Modernize Medicare
Last week, President Trump issued an Executive Order directing the Department of Health and Human Services (HHS) to advance a series of changes for the Medicare program. These changes aim to provide more health plan options for Medicare beneficiaries, modify Medicare fee-for-service (FFS) payments, and reduce regulatory burden, among others.
WHAT’S IN IT?
The Executive Order addresses several major provisions within Medicare, outlined below:
- Medicare FFS Reimbursement: Within 6 months, HHS must submit a report to the President that identifies approaches to modify Medicare FFS payments to more closely reflect the prices for services in Medicare Advantage and the commercial insurance market. Some policy analysts are concerned that this provision leaves open the possibility to make Medicare more expensive by partially tying Medicare provider payments to commercial insurance payments.
- Reducing Regulatory Burden: HHS must propose reforms to the Medicare program within one year to enable providers to spend more time with patients, with the goal of eliminating regulatory billing requirements, supervision requirements, and all other Medicare licensure requirements that are more stringent than applicable Federal/State laws require and that limit professionals. This also includes a comprehensive review of policies that create disparities in reimbursement between physicians and non-physician practitioners.
- Improved Access through Network Adequacy: HHS must issue a regulation to adjust Medicare Advantage network adequacy requirements, and, in doing so, improve access to providers and plans.
- More Plan Choices for Seniors: The Order directs HHS to provide beneficiaries more diverse, affordable plan options within one year. This must include innovative Medicare Advantage benefit structures/plan designs, as well as improved telehealth services. These efforts must ensure that FFS Medicare is not promoted over Medicare Advantage.
- Alternative Payment Methodologies: The Order includes a statement of support for alternative payment methodologies that link to value, increased choice, and lower provider regulatory burdens.
- Eliminating Fraud, Waste, and Abuse: HHS must propose changes to the Medicare program, to take effect by January 1, 2021, that combat fraud, waste, and abuse in Medicare.
The Order notes that the administration will focus on improving market-based approaches in the current system as they move forward. The President directs Medicare to “adopt and implement those market-based recommendations” pursuant to his 2017 Executive Order.
The Order directs HHS to issue a series of regulatory reforms and policy changes in the next six months to one year. HHS has already begun to implement several of these required changes, including patient access to their health care data.