Seema Verma, the nominee to lead the CMS, said during her confirmation hearing Thursday that she may claw back parts of a rule that overhauled managed Medicaid programs. She also opposes turning Medicare into a voucher program and thinks rural providers shouldn't face risk in alternative payment models.
Verma told the Senate Finance Committee that one of her first priorities will be re-assessing a rule issued under the Obama administration that required states to more vigorously supervise the adequacy of plans' provider networks and encouraged states to establish quality rating systems for health plans. Verma said she wanted to determine whether the rule would burden states.
"States will spend millions of dollars implementing that particular regulation, and we have to ask ourselves what will we achieve?” asked Verma, wondering if it would result in better health outcomes.
Her testimony reflects her experience working with state Medicaid agencies. Considered to have the most Medicaid experience of any administrator in the agency's history, Verma helped craft expansion plans in states looking to implement conservative-friendly programs that included job-training requirements and premium contributions. From her home state of Indiana alone, Verma's Indianapolis-based firm, SVC, collected more than $6.6 million in consulting fees.
Indiana Medicaid Director Joe Moser, who has worked with Verma on a Medicaid expansion plan, said he had hoped the CMS would drop the managed Medicaid rule in its entirety. “It's the federal government dictating to states how they should run their programs,” Moser said.
On Thursday, Verma seemed open to GOP proposals to turn Medicaid into a block grant or per capita, capped program that would give states more flexibility to spend on covering poor and disabled residents. She said the current system doesn't ensure greater access or improved health outcomes.
“The Medicaid program as a status quo is not acceptable,” Seema said. “I'm endorsing the Medicaid system being changed to make it better for the people relying on it … and whether that's a block grant or per capita cap, there are many ways we can get there.”
Opponents of the GOP plans say states could lose millions in federal funds, leading them to cut their Medicaid populations. Verma said she would ensure states were held accountable for improved outcomes and adequate access.
Verma has little Medicare experience, something that Democrats have flagged as one problem. The other being her perceived conflict of interest in regulating states that have paid for her work as a consultant.
Verma twice said she doesn't support a proposal favored by HHS Secretary Tom Price to covert Medicare to a voucher program as a way of ensuring the program's financial solvency.
As Medicare continues to transition from a fee-for-service system to a value-based system consisting largely of alternative pay models, Verma said several times that she would shield rural and small providers from taking on financial risks, but did support holding them accountable for health outcomes.
“Many small providers and rural providers don't have the large financial reserves that bigger health systems have," Verma said.
Sen. Ron Wyden (D-Ore.), the ranking Democrat on the Finance Committee, said that sounded like she wanted to keep Medicare a fee-for-service system. The CMS under the Obama administration set goals to move away from fee-for-service, which was viewed as prone to abuse and fraud.
Verma denied the claim and said she supports Medicare focusing more on quality of care instead of volume of care.
Democratic senators slammed Verma's lack of knowledge on drug-pricing issues and her views on so-called Medicare extenders, which are provisions of Medicare that have to be renewed by Congress regularly.
Key to whether they'll support of her, will be how she responds to written questions for the record, said Wyden and Sen. Robert Menendez (D-N.J.).
Even without support from Democrats, Verma is expected to be confirmed by the full Senate. For a number of nominees, the GOP-controlled Senate has confirmed Cabinet-level members without any votes from Democrats.