President Trump released a new
executive order October 3 that aims to promote Medicare Advantage while warning “Medicare for All” would threaten access to a Medicare program that seniors overwhelmingly favor today. The executive order aspires to further improve growing participation in Medicare Advantage plans by directing executive agencies to reduce the federal regulatory burden on health care providers and plans. Agencies are also directed to promote innovation and increase plan choices for seniors.
The order directs federal agencies to issue new proposed regulations that could alter provider payments, such as exploring more widespread use of alternative payment methodologies that link payment to value, something WHA has long supported as Wisconsin is a national leader in high-quality health care. The U.S. Department of Health & Human Services (HHS) is also encouraged to adjust Medicare reimbursements to account for time spent with patients and the care provided rather than the clinician’s occupation. To encourage more price competition into Medicare, the order requires HHS to produce a report on how to modify Medicare fee-for-service payments to more closely reflect prices paid for services in Medicare Advantage and commercial insurance. It also directs HHS to ensure Medicare provider payments reward care through site neutrality by encouraging competition and a diversity of sites for patients to access care
One of the main themes of the order is reducing burdensome federal requirements on health care providers, such as:
- Regulatory billing requirements
- Conditions of Participation
- Supervision requirements
- Benefit definitions
- Licensure requirements that prevent providers from working at the top of their scope of practice
The executive order also calls for incentivizing savings and options for Medicare Advantage beneficiaries. One way it proposes to do this is by adjusting network adequacy requirements to improve access to care. Such requirements would be required to account for the competitiveness of health markets and enhanced access to care made possible through telehealth and other innovative technologies. It also calls for more widespread use of Medicare Medical Savings Accounts that can be used in conjunction with high-deductible Medicare Advantage plans, similar to Health Savings Accounts. Lastly, it proposes regulatory changes streamlining the approval process for breakthrough medical devices and telehealth services.
It remains unclear how the administration will attempt to implement the various policy changes called for in the executive order. Some changes could be announced along with already presumed authority, while others will likely require either new rulemaking or would be implemented in conjunction with regular annual proposed rules.
If you have questions, contact WHA’s Director of Federal and State Relations,
Jon Hoelter.