What Happened, What You Missed: July 12-16

CMS Proposes to Extend Some Telehealth Services through 2023

In its physician fee schedule for 2022, the Center for Medicare and Medicaid Services (CMS) proposed extending coverage for some Medicare telehealth services through the end of 2023.  Under the rule, CMS is proposing to remove certain statutory restrictions to allow patients in any geographic location and in their homes access to telehealth services for diagnosis, evaluation, and treatment of mental health disorders and allow for coverage of audio-only telehealth services to apply to counseling and therapy for opioid treatment.  The release of the proposed rule comes just one day after a group of bipartisan House Energy and Commerce Committee members sent a letter to Health and Human Services (HHS) Secretary Xavier Becerra urging the Department to make Medicare coverage for some telehealth services added under the public health emergency permanent.  Comments on the proposed rule are due on September 13. 

Senate Democrats Reach Agreement on $3.5 Trillion Infrastructure Package

On July 13, Senate Majority Leader Chuck Schumer (D-NY) announced an agreement on a $3.5 trillion “human infrastructure” package after a meeting with Democrats on the Senate Budget Committee.  Major proposals include subsidized child care, national paid family leave, free community college, a host of climate change initiatives, and expanding Medicare coverage for vision, dental, and hearing services.  Democrats are hoping to pass the legislation through budget reconciliation, which would allow the bill to advance in the evenly split Senate with a simple majority.  However, it remains to be seen if the White House and Democratic leadership can count on all Senate Democrats to support the package, including moderate Democrats like Sen. Joe Manchin (D-VW), who is concerned about how the legislation will be paid for.

Drug Overdose Deaths Hit New Record in 2020

According to data from the Centers for Disease Control and Prevention, drug overdose deaths increased nearly 30% from 2019 to hit a record high of over 93,000 in 2020.  A contributing factor is the widespread use of fentanyl, which can halt breathing even if a small amount is ingested. Additionally, the pandemic played a significant role in the increase of deaths, strained health care resources, and made addiction treatment more difficult to obtain.   

CMS Studying How Much Medicare Should Pay for New Alzheimer’s Drug

On July 12, CMS launched a National Coverage Determination analysis to determine whether and under what circumstances Medicare should cover Biogen’s recently approved Alzheimer’s drug Aduhelm. Aduhelm has attracted controversy for its high price tag of $56,000 and inconsistent efficacy in clinical trials. Furthermore, on July 15, a group assembled by the Institute for Clinical and Economic Review unanimously agreed that Aduhelm does not work better than existing Alzheimer’s treatments. However, CMS will propose a decision within six months and then allow stakeholders to comment within a 30-day period with CMS making a final decision three months later. Until then, Medicare Administrative contractors will be left to make coverage determinations for the Alzheimer’s drug. 

ICMYI: Library of Congress Reopens to the Public

On July 15, the Library of Congress reopened to the public, marking a major step in reopening the US Capitol complex.  Visitors are required to get tickets online for a timed entry on Thursday, Friday, or Saturday, and face masks are required for all visitors regardless of vaccination status.  The library’s Thomas Jefferson building is considered an architectural gem and was modeled after the Pantheon in Rome.  However, it’s unclear when the Capitol itself will reopen to the public. 

CMS Puts Geo Model on Hold

On March 1, the Center for Medicare and Medicaid Services (CMS) announced its Geographic Direct Contracting Model is “currently under review” until further notice.   While CMS has yet to provide a reason for the pause, criticism from industry stakeholders and the new Center for Medicare and Medicaid Innovation (CMM) Director may explain the pause.

Announced in December 2020, the Geographic Direct Contracting Model, or the “Geo Model,” envisions using direct contracting entities (DCEs) to build integrated relationships with health care providers and coordinate care for Medicare beneficiaries in designated geographic regions.  The model, which had been under development for two years, builds on lessons learned from the Next Generation ACO model, Medicare Advantage, and other initiatives.

However, the Geo Model is the only CMMI model that has been paused by the new Administration so far.   In the absence of an official justification from CMS, one of the reasons why the model may have been put on hold was criticism from health care stakeholders.  In a December 2020 letter to then-CMMI Director Brad Smith, the National Association of ACOs warned the model could generate confusion among beneficiaries over who is compelled to participate.  Additionally, the Center for Medicare Advocacy urged the then-Biden Transition Team in a December 2020 letter to halt the Geo Model due to uncertainty over how the model would work with other forms of insurance such as Medigap.

The move to suspend the Geo Model is not entirely without precedent.  The Biden Administration paused or withdrew numerous actions by the previous Administration since assuming power, which is typical for new presidential administrations.  For instance, CMS has withdrawn proposed rules on oversight for accrediting organizations, revisions to dialysis coverage requirements, and changes to Medicare Part A enrollment requirements since January 20. 

It should be noted that not all stakeholders oppose the Geo Model.  In a March 4 letter, America’s Physician Groups urged CMMI to restart the model as soon as possible due to “extensive financial investments” participating providers have already made in preparation for the model’s launch, as well as a genuine belief that the model represents a meaningful shift away from the fee-for-service model.

In addition to external criticism, pressure to put the Geo Model on hold may have come from within CMMI itself.  Recently, the Biden Administration tapped Liz Fowler to serve as CMMI Director.  Prior to her new leadership role at CMS, Fowler served as Executive Vice President for Programs at the Commonwealth Fund, where she co-authored a December 2020 blog post about the Geo Model.  While the blog post largely served as an explainer for the model, it raised several questions, including how CMS would be able to produce savings CMS had projected and whether CMS is adequately tracking beneficiaries’ use of services under the model.

Thus, pressures from both inside and outside CMS have likely led to the Administration’s decision to suspend the model for the time being.  That said, while not knowing yet where CMMI may take the geographic-based care and payment model, it certainly seems possible that the Administration could choose to pause other CMMI models in the future.