RISE summarizes recent regulatory news.

MedPAC considers standardizing benefits in MA plans

During its most recent meeting, the Medicare Payment Advisory Commission (MedPAC), which offers Medicare policy guidance to Congress, had an initial discussion about the benefits and challenges to standardizing benefits in Medicare Advantage (MA) plans. Commissioners noted that the average MA beneficiary now has more than 30 plans to choose from, which can make it difficult to compare plans that best meet his or her needs. Standardizing plans may be a way to make that process easier. During the presentation, commissioners sought out initial impressions about a standardized approach. They looked at how standardized benefits have been used in other health insurance markets, such as Medigap, and the variations in MA cost sharing for Part A and Part B services. Among the challenges discussed: Standardization would focus on enrollee cost sharing, questions as to whether insurers would be able to offer plans with the same package but different provider networks, and whether it would be tied to actuarial value or the use of detailed plan designs.

Requiring all plans to use standardized designs would cause disruption for MA enrollees, but the extent would depend on how closely the standardized plans would resemble current plan designs. Commissioners also discussed potential payment implications, including difficulty in predicting plan bidding behavior and plans would have fewer ways to respond to changes in payment rates. Later in the fall, commissioners will look at non-Medicare supplemental benefits.

CMS seeks input on health care access, provider experiences, health equity, and PHE flexibilities

The Centers for Medicare & Medicaid Services (CMS) this week released a Request for Information (RFI) that seeks public input on accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency.

The RFI aims to gather feedback and perspectives related to challenges and opportunities for CMS to embed health equity into its efforts to encourage innovation, reduce burden, and create efficiencies across the health care system.

“Advancing health equity is core work of the Centers for Medicare & Medicaid Services,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “That’s why I am inviting stakeholders to help achieve our goal of an equitable and efficient health system, by working with us as we transform the health care experience for the individuals we serve. Health equity is embedded within the DNA of CMS and serves as the lens through which we view all of our work.”

CMS wants to better understand individual and community-level burdens, health-related social needs, and opportunities for improvement that can reduce disparities and promote efficiency and innovation across its programs. The agency seeks information related to strategies that successfully address drivers of health inequities, including opportunities to address social determinants of health and challenges underserved communities face in accessing comprehensive, quality care. For example, challenges accessing care may include understanding coverage options, receiving culturally and linguistically appropriate care, accessing oral health services, and accessing comprehensive and timely health care services and medication.

The RFI also wants information to better understand the factors that impact provider wellness and learn more about the distribution of the health care workforce. The agency said it is particularly interested in understanding the greatest challenges for health care workers in meeting the needs of individuals, and the impact of CMS policies, documentation and reporting requirements, operations, and communications on provider experiences.

Comments received in response to the RFI will be used to identify opportunities for improvement and to increase efficiencies across CMS programs. The RFI is open for a 60-day public comment period beginning September 6. Comments must be received by November 4 to be considered.