President Trump signed an Executive Order on October 3, 2020 aimed at protecting and improving the Medicare program. The Order outlines steps to improve fiscal sustainability of the Medicare program and plans to increase choices, flexibility and value. Below is a summary of the actions requested to be carried out by the Secretary of the Department of Health and Human Services.
By January 1, 2021, the Secretary will propose regulatory changes to combat fraud, waste and abuse in the Medicare program.
Within 180 days of the Order, the Secretary will:
- Identify approaches to modify Medicare fee-for-service (FFS) payments to more closely reflect those paid by Medicare Advantage (MA) and commercial insurers, and to “inject” market pricing into Medicare.
- Recommend approaches to transition toward “true” market-based pricing in the FFS program, including competitive bidding and using MA-negotiated rates to set FFS rates.
- Preserve Social Security benefits for seniors who choose not to receive Medicare Part A coverage, and to streamline the Medicare enrollment process for beneficiaries.
Within one year of the Order, the Secretary will:
- Propose regulation to encourage more innovative MA benefit structures and plan designs.
- Include a payment model that extends to beneficiaries a share of the program’s savings through rebates or cash, incentivizing beneficiaries to seek high-value care.
- Make sure that FFS Medicare is not advantaged or promoted over MA with regard to its administration.
- Propose regulations to adjust network adequacy requirements for MA plans by enhancing access to telehealth or other innovative technologies.
- Recommend regulation to eliminate burdensome regulatory billing requirements, ensure appropriate reimbursement by Medicare for time-spent with the patient and review regulations that result in payment disparities between physicians and non-physician practitioners and are based on the actual work performed.
- Propose regulation to: facilitate the approval and coverage of innovative products and advances in telehealth technology and remove disincentives for MA plans to cover these services if they’re not otherwise covered by CMS; minimize the time and steps between FDA approval and coverage decisions by CMS; clarify reasonable and necessary standards and those used for coverage determinations; encourage competition and diversity in sites for care.
- Recommend regulation to facilitate the dissemination of quality and cost data to seniors so they can make informed decisions, and use Medicare claims data to educate providers about practice patterns that could be harmful to patients or which are outside recommended standards of care.
- Remove barriers to private contracts that allow Medicare beneficiaries to obtain care of their choice at market prices.