RISE looks at the latest regulatory news that impacts Medicare and Medicaid.

Seema Verma: The country must gradually resume non-COVID-19 health care
In an opinion piece published by CNN, Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), wrote that it was the right call to postpone non-emergency elective surgeries and procedures at the onset of COVID-19, but it’s now time to provide in-person care for non-COVID-19 treatment in certain areas of the country. That care includes in-person visits for patients who need surgery, procedures, preventive care, or evaluation for chronic conditions. “For the financial survival of a large portion of our nation's health care system—and the critical medical care they provide—we must gradually reopen,” she wrote. CMS has published recommendations on how states and localities can begin to reopen. Once the guidelines are met, she said clinicians and health care facilities should work with local and state health officials to determine the best way to resume in-person care.

MedPAC’s annual report to Congress pushes for value-based care payments
The Medicare Payment Advisory Commission (MedPAC) this week released its annual report to Congress, outlining a multiyear effort to broaden the use of value-based payment in Medicare. The Commission said that unless changes are made to the way Medicare pays for services and how it provides and delivers care, the Medicare program will remain on an unsustainable track. Congress can look to improvements in Medicare Advantage and accountable care organization programs as a starting point for the work, it said. The 251-page report calls for rapid development of alternative payment models and care delivery models. Under an improved Medicare program, most beneficiaries would receive care through a variety of accountable entities that have incentives to both control overall costs and improve quality. MedPAC said that ideally incentives would be designed to encourage beneficiaries to choose one of these entities to receive their care and encourage incentives for providers to participate in value-based care. “The Commission recognizes that, traditionally, the health care delivery system has been slow to change, and as a result, much of Medicare’s payment apparatus remains connected to legacy payment models. However, the coronavirus pandemic has demonstrated that the system is capable of rapid change when circumstances require it to do so,” the report said.

Senators urge permanent adoption of telehealth expansion
CMS has indicated a desire to expand telehealth benefits more widely beyond the COVID-19 pandemic and now 30 Senators are calling for Congress to permanently expand telehealth services. In a June 15 letter, a bipartisan group of senators, led by Brian Schatz, D-Hawaii, said telehealth during the COVID-19 outbreak has ensured that Medicare beneficiaries received the care they need. It also proved that telehealth is effective and convenient. “Americans have benefited significantly from this expansion of telehealth and have come to rely on its availability,” Schatz wrote. “Congress should expand access to telehealth services on a permanent basis so that telehealth remains an option for all Medicare beneficiaries both now and after the pandemic. Doing so would assure patients that their care will not be interrupted when the pandemic ends. It would also provide certainty to health care providers that the costs to prepare for and use telehealth would be a sound long-term investment.”

MACPAC report calls for improved care for dual-eligibles, enrollment in integrated care models
The Medicaid and CHIP Payment and Access Commission’s June report to Congress called for the need to better integrate Medicaid and Medicare benefits to improve the care experience and health outcomes for the 12.2 million individuals who are dually eligible for programs. The 214-page report addresses fundamental challenges facing Medicaid; provides an analysis and recommendations to encourage enrollment of more dually eligible beneficiaries in integrated care models and expand the availability of integrated models; suggests the need to increase enrollment in the Medicare Savings Program; and addresses Medicaid’s statutory role as the payer of last resort. The commission notes that the report was developed prior to COVID-19, but the concerns raised remain relevant. ”Issues affecting dually eligible beneficiaries, and pregnant women and their infants in particular may be of even heightened concern during the pandemic, and the issues affecting these populations will continue to require policymakers’ attention when the pandemic is over,” the commission wrote.

FCC proposed $225M fine for massive spoofed health insurance robocalls
The Federal Communications Commission (FCC) has proposed a $225 million fine against Texas-based health insurance telemarketers for apparently making as many as 1 billion illegally spoofed robocalls.  This is the largest proposed fine in the FCC’s 86-year history, reflecting the seriousness of the apparent violations by John C. Spiller and Jakob A. Mears, who used business names including Rising Eagle and JSquared Telecom. The robocalls falsely claimed to offer health insurance plans from well-known health insurance companies such as Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group. The FCC’s investigation found that the robocalls made by Rising Eagle were spoofed in order to deceive consumers, targeted millions of Do Not Call list participants, and were received on many wireless phones without prior consumer consent. Commissioner Brendan Carr said the case is particularly troublesome because it’s not merely about annoying calls interrupting dinner, the calls were designed to defraud Americans on health insurance.