This article addresses two components of the new governing architecture (NGA) that help to reform the delivery of health care and to control costs of the health care system: the Center for Medicare and Medicaid Innovation (CMMI) and the Independent Payment Advisory Board (IPAB). The republican controlled federal government has partially disassembled these two components, threatening the effectiveness of federal delivery system reform and cost control initiatives.
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References
1.
G.R.Majette, “Global Health Law Norms and the PPACA Framework to Eliminate Health Disparities,”Howard Law Journal55, no. 3 (2012): 887-936.
2.
G.R.Majette, “PPACA and Public Health: Creating a Framework to Focus on Prevention and Wellness and Improve the Public’s Health,”Journal of Law Medicine & Ethics39, no. 3 (2011): 366-379.
3.
Republican Leadership for the United States House of Representatives, A Better Way, Our Vision for a Confident America, Health Care, June 22, 2016 at 2.
4.
A Better Way, supra note 3 at 32; S.Muchmore, “GOP May Try to Hobble CMS Innovation Center,”Modern Healthcare, November7, 2016.
5.
Muchmore, supra note 4. A statutory amendment would be required to cut CMMI’s budget because its authorizing language provides that “money is available until it is expended.” Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 3021 (a), 124 Stat 119 (2010) (codified as amended in scattered titles of U.S.C); 42 U.S.C.A. § 1315a (f)(1).
6.
United States House of Representatives Tom Price, M.D., Charles W. Boustany, Jr., M.D., and Erik Paulsen letter to CMS Acting Administrator Andrew Slavitt and Deputy Administrator and Chief Medical Officer, Patrick Conway, M.D. (September 29, 2016); A Better Way, supra note 3 at 11.
7.
Congressman Price et al., letter to CMS Administrator Slavitt p. 3.
8.
Muchmore, supra note 5.
9.
Id.; P.Orzag, “US Health Care Reform Cost Containment and Improvement in Quality,”JAMA316, no. 5 (August2, 2016): 493, 494.
Health Care Transformation Task Force letter to President-Elect Donald Trump, Vice-President Elect Mike Pence, Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer, Speaker Paul Ryan, House Minority Leader Nancy Pelosi, Secretary-Designate of Health and Human Services Tom Price, and CMS Administrator-Designate Seema Verma (December 6, 2016).
12.
HCTTF December Ltr p. 4–5.
13.
Id. at 2, 4.
14.
PPACA§ 3021 (a); Section 1315a(b)(2)(B) describes models to be tested including those that integrate care for individuals dually eligible for Medicare and Medicaid and models that test state all-payer payment reform. 42 U.S.C. § 1315a(b)(2) (B)(x)–(xi).
15.
CMS Center for Medicare and Medicaid Innovation, Report to Congress at 36 (December 2014).
16.
Id.; CMS Center Medicare and Medicaid Innovation, Report to Congress at 19 (December 2016).
17.
CMMI 2016 Report to Congress at 70. In 2015, CMMI required Model Test States to submit initiatives that were “patient-centered, broad-based, transformative, accountable for the total cost of care, feasible, and able to be evaluated.” It also required the Model Test States to propose models that comply with the Medicare Access and Chip Reauthorization Act of 2015 and the 2015 DHHS Delivery System Reform Goals tying Medicare payments to value. Id. at 70–71.
18.
Maryland Department of Health and Mental Hygiene, The Maryland All-Payer Model Progression Plan: Proposal to the Centers for Medicare & Medicaid Services at 24-25, 40, 44 (December 16, 2016); Health Services Cost Review Commission, All-Payer Model Progression Plan — Draft Strategic Blueprint at 6 (August 1, 2016 presentation to the HSCRC Advisory Council); Health Services Cost Review Commission, Progression Strategy Discussion at slides 27–29 (August 1, 2016 PowerPoint presentation to the HSCRC Advisory Council).
19.
Maryland Department of Health, The Maryland All-Payer Model Progression Plan: Update to the December 2016 Proposal to the Centers for Medicare and Medicaid Services at 31 (May 2018); Maryland Total Cost of Care Model State Agreement at ¶ 11(b)(iv)(3)(July 9, 2018).
The other models focus on Advanced Alternative Payment, Consumer-Directed Care & Market-based Innovation, Physician Specialty, Prescription Drugs, Medicare Advantage Innovation, Mental & Behavioral Health, and Program Integrity. Id.
23.
PPACA § 3403; 42 U.S.C. § 1395kkk.
24.
Coons v. Lew, 762 F.3d 891(9th Cir. 2014).
25.
A Better Way, supra note 3 at 31-32.
26.
Id. at 32.
27.
Protecting Seniors Access to Medicare Act, S. 260 (Introduced by Senator Cornyn with 21 republican co-sponsors on Feb. 1, 2017); Protecting Seniors Access to Medicare Act, H.R. 849 (introduced on Feb. 3, 2017).
28.
S. 1771 (Sept. 7, 2017).
29.
While the House passed H.R. 849, S. 260 never made it out of the Senate Finance Committee.
30.
Bipartisan Budget Act of 2018, H.R. 1892, Pub. L. 115-123 (Sec. 52001 Repeal of the Independent Payment Advisory Board).
Congressional Budget Office Cost Estimate, H.R. 849 Protecting Seniors’ Access to Medicare Act (Oct. 27, 2017); Medicare Boards of Trustees, 2018 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 187 (June 5, 2018).
33.
Medicare Boards of Trustees, 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 180 (July 22, 2015); Medicare Boards of Trustees, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 179 (July 13, 2017).
34.
Please see, G.R.Majette, “The ACA’s New Governing Architecture and Innovative State Delivery System Reform Initiatives” for an in-depth comparative analysis of Maryland’s All Payer Model and the Massachusetts Chapter 224 — An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation (2012)(article on-file with the author).
Maryland Department of Health, The Maryland All-Payer Model Progression Plan: Update to the December 2016 Proposal to the Centers for Medicare and Medicaid Services (May 2018); Maryland Total Cost of Care Model State Agreement (July 9, 2018).
37.
Id.
38.
Massachusetts Health Policy Commission, “2017 Annual Health Care Cost Trends Report,” March 2018, at 12, 16.
