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Lawmakers to CMS: CMMI Has Overstepped Its Authority

September 30, 2016
by Heather Landi
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Close to 200 federal lawmakers sent a letter to Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS) calling out the Center for Medicare and Medicaid Innovation (CMMI) for overstepping its authority by proposing mandatory healthcare payment and service delivery models.

CMMI is charged with piloting, testing and evaluating alternative payment models with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Congressmen Tom Price, M.D., Charles Boustany, M.D., and Erik Paulsen wrote a letter to CMS, which was signed by 179 members of Congress, stating that three recently proposed mandatory models  demonstrate that CMMI has “exceeded its authority, failed to engage stakeholders and has upset the balance of power between the legislative and executive branches.”

In the letter, the legislators state that the proposals would negatively impact patients. "We ask that your cease all current and future planned mandatory initiatives under the CMMI,” the legislators wrote.

The Medical Group Management Association (MGMA) issued a public statement supporting Congressmen Price, Boustany and Paulsen and their efforts to provider oversight of CMMI.

“In a recent letter to the Centers for Medicare and Medicaid Service, 179 members of Congress highlighted CMMI’s overreach of its authority by rolling out mandatory, experimental demonstrations, which impact physician practices and Medicare patients across the nation. MGMA supports these members of Congress as they remind CMMI of its specific statutory role in facilitating the transition from fee-for-service to value-based payment arrangements,” MGMA president and chief executive officer, Halee Fischer-Wright, M.D. wrote.

 The members of Congress state that until recently the tests and models developed by CMMI were implemented on a voluntary, limited-scale basis where “no state, healthcare provider or health insurer had any obligation to participate.”

The letter specifically cites the CMS final rule requiring at least 800 hospitals in 67 geographical areas selected by CMS to participate in a new bundled payment model for hip and knee replacements, the Comprehensive Care Joint Replacement (CJR) Model, as well as a proposed rule requiring thousands of providers to comply with a new drug payment model under Part B of Medicare (the Part B Drug Payment Model). In addition, the legislators also cite the cardiac bundled payment model CMS announced in July that requires some providers to participate in bundled payments for certain cardiac conditions as well as expansion of the CJR model.

The legislators state that the CMMI models were developed without input from impacted stakeholders and fail to include safeguards to protect the “delicate balance of quality, cost and access to care for beneficiaries.” “CMS at best has heeded only part of its statutory duty—‘reducing program expenditures’—at the expense of its other duties—‘preserving or enhancing the quality care’,” the legislators wrote. And the legislators assert that some models tested under demonstration programs failed to produce quality improvements and anticipated cost savings. And, the legislators contend that patients have no choice about their participating in these models.

The lawmakers also contend CMS’ Part B proposal would “rewrite Medicare Part B payment law in 75 percent of the country without going through the Constitutional procedures where legislation is debated and approved by both chambers of Congress, and subsequently signed by the President.”

Fischer-Wright with MGMA wrote in the organization’s public statement, “CMMI must engage in an open and transparent process that incorporates physician input to develop and evaluate new APMs prior to mandatory implementation. Instead of a purely top-down government approach, CMMI should also adopt proven private sector initiatives that advance Medicare’s goal to provide highly quality, cost-effective patient care.”

In conclusion, the legislators called for CMS to “cease all current and future planned mandatory initiatives within the CMMI.” “Additionally, we ask that you commit to ensuring future CMMI models fully comply with current law, including: limiting the size and scope of CMMI demonstrations so they represent true tests rather than wholesale changes to statute; seeking Congressional approval if expansion of test models require changes to the underlying statute; and establishing an open, transparent process that supports clear and consistent communication with physicians and other relevant stakeholders in the development of new CMMI models.”






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