MH: CMS Nominee Would Loosed Managed Care Regs, Open to State Block Grants

CMS Nominee Wants To Protect States and Rural Providers, Opposes Vouchers for Medicare
By Virgil Dickson Modern Healthcare February 16, 2017

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.

Seema Verma, CMS Administrator Nominee, Discusses MACRA, M.D. Burden in First Senate Hearing

by Rajiv Leventhal Healthcare Informatics February 16, 2017

Reducing complexities of CMS rules and regulations, and putting decisions in the hands of doctors and patients were key points made by Verma during today’s Senate hearing

Seema Verma, President Donald Trump’s choice to run the Centers for Medicare and Medicaid Services (CMS), emphasized access to healthcare coverage, patient-centered care, and moving important healthcare decisions away from the government in her first Senate hearing for her nomination, held on Feb. 16.

Verma, president, CEO and founder of SVC, Inc., a national health policy consulting company, faced the Senate Committee on Finance on Thursday morning, bringing her family along to sit next to her for the hearing. Throughout the session, she faced sharp questioning, though perhaps not as hard-hitting as just-confirmed Department of Health and Human Services (HHS) Secretary Tom Price, M.D., received in his two Senate hearings in recent weeks. If confirmed, Verma will replace Andy Slavitt as CMS Administrator, who was an Obama administration appointee.

Verma was questioned hardest by Sen. Ron Wyden (D-Ore.), who several times asked the nominee to give examples of how she will keep Americans insured and asked for specific policy changes she is planning on making. Verma, in response, did not give many details, but reiterated that she has “fought for coverage and better outcomes” her entire career. When Sen. Wyden noted that Sec. Price said the same thing in his hearings, but refused to commit to giving all Americans coverage, Verma said that she wants to make sure that all Americans have access to high-quality and affordable care.

To this end, Wyden pressed Verma on a rule that was released yesterday by CMS, which the federal agency said in a press release, “would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.”

Wyden opined in the hearing that the rule, the first by CMS since Price was confirmed, “meant less coverage, higher premiums and more out-of-pocket costs for working families.” He added that the rule “puts insurance companies over patients.” In response, Verma said that she has not been to CMS or HHS offices and had nothing to do with the development of that rule. Wyden again went back to questioning since he felt that the rule “does the opposite of what Trump said when he stated his goal of insurance for everyone” last month. Verma said she could not comment on the rule, but that both she and the president “are committed to coverage.”

There were further questions and statements as it related to value-based healthcare and healthcare IT during the Senate hearing. Committee Chairman Orrin Hatch (R-Utah) was the first to bring up the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), of which he said work on the law “continues to be bipartisan.” Hatch noted, “The Obama administration took great pains to engage doctors and stakeholders through the initial implementation stage [of MACRA]. Early and often consultation should be the rule and not the exception.”

Verma agreed with the Utah Congressman, saying she applauds Congress for the passing of MACRA. “It was an important step forward to provide stability for providers and move us toward better outcomes,” Verma said. “The most important thing we can do is engage stakeholders not just on the front end, but all the way through. What are they going through and what are their challenges?”

Further touching on MACRA, Wyden brought up that small and rural practices in his state of Oregon are constantly asking him about virtual group reporting—which starting in 2018 will allow small practices to be assessed as a group across the four MIPS (Merit-based Incentive Payment System) performance categories—and about what qualifies as “nominal risk” to qualify for an alternative payment model (APM).

Verma noted a few times that MACRA “will be a challenge for small and rural providers, but that it’s a worthy goal. We have to support them,” she said. “For smaller providers taking risk, they will be reluctant since they don’t have the financial reserves that bigger health systems have. When thinking about holding providers accountable for outcomes, that also depends on patients. So we need to think about strategies for engaging patients so they can work with providers for achieving outcomes. Smaller and rural providers taking on risk will be a formidable challenge,” she said.

Continuing, Verma said that she isn’t sure if rural and small providers “want to take on risk at all.” As such, she added, “When we are designing these programs we have to keep their needs in mind. Larger systems and insurance companies have taken on risk, but even looking at ACO [accountable care organization] models, there’s not a lot of people comfortable taking on risk.”

Wyden then said, listening to Verma’s comments, one could draw the conclusion that she is in favor of fee-for-service, to which Verma responded, “There are concerns with fee-for-service, in terms of rewarding volume over quality. I do support efforts that hold providers accountable for outcomes and increasing the coordination of care. It’s another thing all together in having them take on risk,” she said.