White House reconciliation talks underway, CMMI presents plans

McDermott + Consulting is pleased to provide you with the McDermottPlus Check-up, your regular update on Washington, DC healthcare policy.

This week’s dose

The White House is moving reconciliation talks forward. The Center for Medicare and Medicaid Innovation (CMMI) presents a vision for the next decade of value-based care.


The president and White House officials have summoned members to advance reconciliation. After weeks of deadlock, the White House stepped in to push forward the Democratic majority’s reconciliation package in a series of meetings on Tuesday. The aim was to help reach agreement on a framework for the reconciliation package before the end of the month. Early reports indicate that the compromise will seek to retain as many health provisions as possible, but fund them for a shorter period. Policies likely to be included in the final framework include: a three-year extension of the Affordable Care Act (ACA) advance premium tax credit increases; a three-year ACA-style approach to establishing a federal Medicaid option in states that have not yet expanded; and an undetermined amount of funding for home and community services. Medicare dental, vision, and hearing benefits were also discussed, but it is possible that these benefits could be processed through a voucher program outside of Medicare or discontinued altogether. Drug price reform, which would serve to offset the cost of other policies, remains in motion. As of this week, revenue still hovers around $ 2 trillion, but that figure remains uncertain until a final deal is reached.


CMMI outlined plans for the future of value-based care. On Wednesday, the CMS Innovation Center hosted a special webinar to present its strategic plan and publish a new white paper, “Driving Healthcare System Transformation – A Strategy for the CMS Innovation Center’s Second Decade”. Center management said they would pursue a streamlined portfolio of models to reduce the complexities and overlap of models that have historically presented challenges and barriers to participation. As part of their vision, management discussed making alternative payment models less constraining to participate while placing more emphasis on total cost of care approaches that focus on advanced primary care and care organizations. responsible. The Center also wants to ensure that outcome measures are meaningful for patients and that health equity and access to care are priorities.

The strategic plan and webinar were largely silent on specialty care models, including episodic and medical oncology models, but affirmed CMMI’s intention to pursue models that align with the plan. drug pricing from the Department of Health and Social Services. Examples of these include Part B models, shared savings models, and pooled payments. CMMI is encouraging feedback and input from stakeholders on the new strategy and will be hosting a series of listening sessions, the first taking place in November.


  • Listen here: In this week’s break room, our resident regulatory experts Sheila Madhani and Deborah Godes discuss the upcoming final rules for the Outpatient Hospital Prospective Payment System (OPPS) and Physician Fee Schedule.

Quick shots

The United States Food and Drug Administration has cleared booster shots of Moderna and Johnson & Johnson COVID-19 vaccines as well as “mix and match” booster doses.

Health, Energy and Trade Subcommittee Chair Anna Eshoo (D-CA) introduced a stand-alone bill to establish the Agency for Advanced Research Projects for Health (ARPA-H) , the cutting-edge medical research entity requested by President Biden.

The Health Resources and Services Administration issued an information gathering request seeking comment on the reporting requirements for the Provider Relief Fund.

Senator Patty Murray (D-WA) and Representative Frank Pallone (D-NJ) wrote a letter to the Departments of Labor, Treasury and Health and Human Services in support of the independent dispute resolution process described in the most recent regulation implementing the No Surprises program. Act, which deals with surprise medical billing.

The Biden administration has released a fact sheet outlining its plan to facilitate immunization of children aged 5 to 11 while awaiting emergency use clearance for this population.

Senators Roger Marshall (R-KS), Kyrsten Sinema (D-AZ) and John Thune (R-SD) introduced the law on improving early access to care for the elderly aimed at reforming the use of prior authorization by Medicare Advantage plans.

CMS has developed a website to facilitate information sharing and best practices for innovative home and community service models among state Medicaid agencies.

Diagnosis next week

There will be an energy and trade legislative hearing on policies to support caregivers and patients. Education and Labor will hold a hearing on workplace COVID-19 vaccination policies. Veterans Affairs Canada will review patient safety.

About Alexander Estrada

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