Living in a MACRA world: How one law will change care delivery 801.538.5082 | info@accountablecareLC.org | 4001 South 700 East suite 700, Salt Lake City, UT 84107
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Agenda • ACLC updates • Introduction of guest presenters • Presentation by Clay Alspach, Leavitt Partners • Presentation by Dr. Mark McClellan, Duke University • Opportunity for Q&A Members can submit questions ahead of time by using the question box of the Zoom window
Upcoming member event(s) ACLC Member Meeting at HIMSS17 Orlando, FL February 20 th • Co-located with the HIMSS17 Annual Conference • Members of the ACLC are invited to attend a second Healthcare Conference day on Tuesday, February 21st hosted by Leavitt Partners Look for registration links in weekly news every Tuesday
Guest Presenter Clay Alspach Principal Leavitt Partners
Post-Election, New Administration Insights
Top 10 He Health lth Poli licy cy Ac Actio ions ns to Watch h Republican governors who expanded 1 Substantial health care legislation in 6 Medicaid will push back on repeal 2017 - ACA repeal/replace, CHIP and FDA user fee reauthorizations Look to the June report from the House Republican Key appointments will reflect planning done 2 7 Health Care Reform Task Force and Price’s health by transition team (Price, Verma) reform bill for policies that will be top priorities in replace Use of reconciliation to repeal some 3 Private sector collaboration is critical to continue to 8 ACA components where possible – address quality, value based care and coverage H.R. 3762 is base Some ACA areas are too embedded MACRA will sustain; 2017 performance period 4 9 in law and the health care system will provide key data/feedback for policymakers to repeal 1 Private sector pushback on other ACA GOP disagreement on how far to push on 5 0 components where change is underway Medicare reform 7
2017 Co Congressio essional al Ag Agenda Reconcili liat ation ion for Suprem eme Cour urt Possib ible le ACA and and Cabine inet UFAs Entit itlem lemen ent Refo forms Nominat ination ions (March-Sept.) (Repeal and Replace, (Jan-Feb.) Side-car for Congressional Agenda Medicare and FY18 Medicaid reform, Appropria iation ions CHIP Bills reauthorization, (April-Sept.) Medicare, Medicaid Tax Public Health Reconcili liat ation ion extenders) Veh ehic icle le (Jan-July) FY18 (April-July) Cong ngres ession ional l Bud udget and FY18 POTUS Bud udget Recon oncili liat ation ion (March) Inaug augur urat ation ion Instructions (Jan. 20) (April) Jan. 2017 Feb. 2017 March 2017 April 2017 May 2017 June 2017 July 2017 August 2017 September 2017 Oct. – Dec. 2017 Expiring Policies FY 17 Approps Expire Sept. Medic icare are, Medic icai aid, CHIP Pub ublic ic Heal alth h Expires Sept. Debt Cei eili ling Exten enders UFA Reach ached ed Expire Sept. or Pink slips sent UFAs (summer) 8 (July) Expire Sept. Dec.
Repeal and Replace 2016 Key Events (Reconciliation Process) Key: President House & Senate House Senate President Submits No Further Action FY2017 Budget House Budget Committee Expected 2/8/2016 Approves FY 2017 Budget (House 12/31/2016 C.R. 125 filed on March 23) 3/16/2016 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 9
Repeal and Replace First Repeal & Replace Reconciliation House E&C, W&M and Committees submit legislative text of Obamacare Key: repeal/replace reconciliation bill to House President Budget Committee House & Senate 1/25/2017 House Budget Committee approves Obamacare 100 th Day in Office Repeal/Replace reconciliation bill House 1/31/2017 Senate House approves Obamacare Repeal/Replace Mid-May reconciliation bill; Sends to Senate 2/3/2017 2017 Apr Jan Feb Mar May 3/17/2017 2/6/2017 4/10/2017 President Trump Statutory Deadline for President President Trump signs Repeal/Replace Trump’s Fiscal Year 2018 Budget submits Fiscal Year reconciliation bill 2018 Budget 3/10/2017 House and Senate approve modified Repeal/Replace reconciliation bill (potential sidecar for non-reconciliable 1/13/2017 House considers approves FY issues); Sends to President Trump 2017 Budget Report sent by Senate 1/9/2017 Consideration by Senate of 10 Fiscal Year 2017 Budget
Repeal and Replace Second Tax Reconciliation Key: House W&M submits legislative text of tax President provisions (including possibly Obamacare taxes) to House Budget Committee (2) House & Senate Jun House House Budget House approves modified Senate House approves Committee reconciliation tax bill; Sends to reconciliation tax bill; approves President Trump Sends to Senate reconciliation tax Aug Jul bill (3) President Trump signs reconciliation bill Jun/Jul Aug 2017 May Jun Jul Aug Jun Jul Senate approves modified reconciliation House and Senate approve Fiscal Year 2018 Budget tax bill; Goes back to House Conference Report; 2nd reconciliation process begins. (1) May Jul House and Senate Approve Fiscal Year 2018 Senate Finance Committee approves Budgets reconciliation bill May House and Senate Budget Committees 11 approve FY2018 Budgets
Election Outcome Impact Target Value-Based Payment Statutory curtailing of CMMI authority* (e.g. expansion authority, mandatory demos, future funding; does not mean elimination) MACRA delay or hindrance Medicaid Block grants* Medicaid 1115 waiver flexibility* End Medicaid Expansion* FMAP changes* Medicare Medicare Provider Cuts Age 55 “Medicare for All” Action Likely IPAB repeal* Potential Action Health IT Action Less EHR flexibility, promotion of interoperability, anti-blocking Likely Telehealth (e.g. CONNECT for Health) Action Unlikely *=Eligible and possible 12 for Reconciliation
Election Outcome Impact Target Tax Issues Cadillac Tax Repeal* Medical Device Tax Repeal* Health Insurance Tax Repeal* Insurance Markets Repeal Individual Mandate* Repeal Employer Mandate* Public Option ACA Marketplace changes (privatize healthcare.gov, state control of state exchanges) Selling products across state lines Insurance regulation reforms (essential health benefits, 3:1 age-banding, guaranteed issue, lifetime limits, repeal or modify consumer subsidies (CSR and APTCs), metal tiers, MLR, RA) 1332 waiver flexibility FDA Action Likely Drug Pricing--Transparency Drug Pricing – Price Controls Potential Action Drug Pricing (e.g. importation) Action Less Likely FDA Reform Action Unlikely *=Eligible and possible UFAs 13 for Reconciliation
MACRA
MACRA Delay or Hindrance? Key Developments Post-Election Likelihood of Action • ACA related initiatives such as the individual mandate, independent Administration payment advisory board, and various taxes are higher priorities for • Trump’s election not likely to impact MACRA’s roll out given its change passage received 90% Senate support. • Rep. Tom Price (R-GA), who has been nominated as HHS Secretary, • 2017 performance period will provide key data/feedback. Price will be a key player to watch on MACRA. He had concerns regarding and CMS will watch closely. the proposed rule, but the changes in final rule moved in his direction. • If Congress or new HHS secretary reduces CMMI’s authority, a few payment models may be at risk. • Rep. Michael Burgess (R-TX), who is the author of MACRA, was just named as Chair of the Health Subcommittee of the House Energy Congress Commerce Committee. He also will be a key player to watch. • Payment and delivery reform are largely bipartisan issues. MACRA received overwhelming support. • Similar to above, Congress will watch 2017 performance period closely.
Statutory Curtailing of CMMI? Key Developments Post-Election Likelihood of Action • Some in Congress, including President- elect Trump’s HHS nominee Administration Rep. Tom Price (R-GA), have expressed concerns regarding the Cardiac Bundled Payment Model, the Comprehensive Care Joint • A Trump presidency might lead those lawmakers and new staff Replacement Model, and the Part B Drug Payment model. at CMS to reduce CMMI's role as a payment reform facilitator and rely more on Congress to drive new payment models • It is possible that Republicans will move to limit CMMI's authority in forward. some areas given their recent attacks on it. • Will be easier to slow growth moving forward than disrupt what • Key players to watch include Rep. Price, Rep. Greg Walden (R-OR), has been approved. Rep. Kevin Brady (R-TX), Rep. Michael Burgess (R-TX) and Sen. Orrin Hatch (R-UT) Congress • Congressional Republicans have been critical of CMMI, particularly as CMMI has proposed mandatory programs. • CBO views CMMI favorably due to their believe that it saves CMS money. This will make it harder to Congressional Republicans to limit CMMI’s authority.
Guest Presenter Dr. Mark McClellan Director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy Duke University
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