The Trump administration on Monday signed off Medicaid managed-care changes, but it could wrap up a few more loose ends before President-elect Joe Biden takes office in January. Here's a look at six of the top prospects.
Medicare physician fee schedule
The White House budget office is reviewing Medicare's physician fee schedule. It would permanently allow providers to use telehealth to carry out home visits for so-called evaluation and management services and some visits for people with cognitive impairments, and temporarily continue telehealth services for emergency department visits and other services. The Trump administration plans to simplify billing and coding requirements for office and outpatient visits, boost several bundled payments and expand providers' scopes of practice. It also wants to revise the Medicare Shared Savings Program for 2020 and change how CMS calculates rates under the physician fee schedule.
Medicare payment rule for outpatient services
The White House budget office is reviewing Medicare's payment rule for outpatient services. It could increase total payments to providers by $7.5 billion to nearly $84 billion and slash reimbursements for 340B-acquired drugs by more than 6%. It would phase out the inpatient-only list, allow ambulatory surgical centers to deliver more services and streamline the hospital star-rating system. CMS also plans to relax supervision requirements for outpatient therapeutic services and make it easier for physician-owned hospitals with high shares of Medicaid patients to expand their facilities. Therapists and long-term care providers roundly criticized CMS' proposal to cut reimbursement for therapy services by 9%.
Self-referral and anti-kickback reforms
Officials and providers argue that the Stark law, which was originally implemented in 1989 to prevent physicians from profiting off referrals to Medicare providers that they or a family member had a financial stake in, has deterred them from participating in payment models in which physicians and hospitals share the financial rewards for cost-effectively delivering higher-quality care. But the administration's plans to reform those rules took a back seat during the COVID-19 pandemic. The White House budget office has been reviewing them since July.
The Trump administration has been working on reforming patient privacy rules to help the healthcare system move to value-based care by encouraging providers to adopt better care-coordination and case-management practices. The updated regulations would also give patients more access to their HIPAA-protected health information. The White House budget office approved the proposed rule last week, but HHS hasn't made it public yet.
HHS recently proposed to sunset rules 10 years after the agency issues them if HHS doesn't assess and, if necessary, review a rule quickly. Comments are due Jan. 4. The department could try to finalize the rule before Biden takes office, as deregulation was a key focus for Trump and his political appointees.
Tennessee's Medicaid block grant
CMS could approve Tennessee's proposal for a Medicaid block grant. State officials unveiled the plan last fall, claiming Tennessee could provide its Medicaid-eligible population with quality healthcare coverage at lower cost if the CMS granted it more flexibility in providing low-income people with health insurance. But the proposal only allows the state to cover more people or add services. Experts are skeptical the plan gives Tennessee enough flexibility to create cost savings. CMS unveiled its block grant demonstration for states in January, but it doesn't have any takers now that Oklahoma voted to expand Medicaid, and the COVID-19 pandemic is pummeling state budgets. Block grants and other Medicaid reforms have been a high priority for CMS Administrator Seema Verma.