Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T09:23:18.708Z Has data issue: false hasContentIssue false

Controlling Health Care Costs under the ACA — Chaos, Uncertainty, and Transition with CMMI and IPAB

Published online by Cambridge University Press:  01 January 2021

Abstract

This article addresses two components of the new governing architecture (NGA) that help to reform the delivery of health care and to control costs of the health care system: the Center for Medicare and Medicaid Innovation (CMMI) and the Independent Payment Advisory Board (IPAB). The republican controlled federal government has partially disassembled these two components, threatening the effectiveness of federal delivery system reform and cost control initiatives.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Majette, G.R., “Global Health Law Norms and the PPACA Framework to Eliminate Health Disparities,” Howard Law Journal 55, no. 3 (2012): 887936.Google Scholar
Majette, G.R., “PPACA and Public Health: Creating a Framework to Focus on Prevention and Wellness and Improve the Public's Health,” Journal of Law Medicine & Ethics 39, no. 3 (2011): 366379.CrossRefGoogle Scholar
Republican Leadership for the United States House of Representatives, A Better Way, Our Vision for a Confident America, Health Care, June 22, 2016 at 2.Google Scholar
A Better Way, supra note 3 at 32; Muchmore, S., “GOP May Try to Hobble CMS Innovation Center,” Modern Healthcare, November 7, 2016.Google Scholar
Muchmore, supra note 4. A statutory amendment would be required to cut CMMI's budget because its authorizing language provides that “money is available until it is expended.” Patient Protection and Affordable Care Act, Pub. L. No. 111-148, § 3021 (a), 124 Stat 119 (2010) (codified as amended in scattered titles of U.S.C); 42 U.S.C.A. § 1315a (f)(1).Google Scholar
United States House of Representatives Tom Price, M.D., Charles W. Boustany, Jr., M.D., and Erik Paulsen letter to CMS Acting Administrator Andrew Slavitt and Deputy Administrator and Chief Medical Officer, Patrick Conway, M.D. (September 29, 2016); A Better Way, supra note 3 at 11.Google Scholar
Congressman Price et al., letter to CMS Administrator Slavitt p. 3.Google Scholar
Muchmore, supra note 5.Google Scholar
Id.; Orzag, P., “US Health Care Reform Cost Containment and Improvement in Quality,” JAMA 316, no. 5 (August 2, 2016): 493, 494.Google Scholar
PPACA § 3021 (a); 42 U.S.C.A. § 1315a (d)(2)(B)–(C).Google Scholar
Health Care Transformation Task Force letter to President-Elect Donald Trump, Vice-President Elect Mike Pence, Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer, Speaker Paul Ryan, House Minority Leader Nancy Pelosi, Secretary-Designate of Health and Human Services Tom Price, and CMS Administrator-Designate Seema Verma (December 6, 2016).Google Scholar
HCTTF December Ltr p. 45.Google Scholar
Id. at 2, 4.Google Scholar
PPACA§ 3021 (a); Section 1315a(b)(2)(B) describes models to be tested including those that integrate care for individuals dually eligible for Medicare and Medicaid and models that test state all-payer payment reform. 42 U.S.C. § 1315a(b)(2) (B)(x)–(xi).Google Scholar
CMS Center for Medicare and Medicaid Innovation, Report to Congress at 36 (December 2014).Google Scholar
Id.; CMS Center Medicare and Medicaid Innovation, Report to Congress at 19 (December 2016).Google Scholar
CMMI 2016 Report to Congress at 70. In 2015, CMMI required Model Test States to submit initiatives that were “patient-centered, broad-based, transformative, accountable for the total cost of care, feasible, and able to be evaluated.” It also required the Model Test States to propose models that comply with the Medicare Access and Chip Reauthorization Act of 2015 and the 2015 DHHS Delivery System Reform Goals tying Medicare payments to value. Id. at 70–71.Google Scholar
Maryland Department of Health and Mental Hygiene, The Maryland All-Payer Model Progression Plan: Proposal to the Centers for Medicare & Medicaid Services at 24-25, 40, 44 (December 16, 2016); Health Services Cost Review Commission, All-Payer Model Progression Plan — Draft Strategic Blueprint at 6 (August 1, 2016 presentation to the HSCRC Advisory Council); Health Services Cost Review Commission, Progression Strategy Discussion at slides 27–29 (August 1, 2016 PowerPoint presentation to the HSCRC Advisory Council).Google Scholar
Maryland Department of Health, The Maryland All-Payer Model Progression Plan: Update to the December 2016 Proposal to the Centers for Medicare and Medicaid Services at 31 (May 2018); Maryland Total Cost of Care Model State Agreement at ¶ 11(b)(iv)(3)(July 9, 2018).Google Scholar
CMMI 2016 Report to Congress at 70.Google Scholar
CMMI, Request for Information, September 2017, RFI, available at <https://innovation.cms.gov/Files/x/newdirection-rfi.pdf> (last visited October 22, 2018).+(last+visited+October+22,+2018).>Google Scholar
The other models focus on Advanced Alternative Payment, Consumer-Directed Care & Market-based Innovation, Physician Specialty, Prescription Drugs, Medicare Advantage Innovation, Mental & Behavioral Health, and Program Integrity. Id.Google Scholar
PPACA § 3403; 42 U.S.C. § 1395kkk.Google Scholar
Coons v. Lew, 762 F.3d 891(9th Cir. 2014).Google Scholar
A Better Way, supra note 3 at 31-32.Google Scholar
Id. at 32.Google Scholar
Protecting Seniors Access to Medicare Act, S. 260 (Introduced by Senator Cornyn with 21 republican co-sponsors on Feb. 1, 2017); Protecting Seniors Access to Medicare Act, H.R. 849 (introduced on Feb. 3, 2017).Google Scholar
S. 1771 (Sept. 7, 2017).Google Scholar
While the House passed H.R. 849, S. 260 never made it out of the Senate Finance Committee.Google Scholar
Bipartisan Budget Act of 2018, H.R. 1892, Pub. L. 115-123 (Sec. 52001 Repeal of the Independent Payment Advisory Board).Google Scholar
March 20, 2010 CBO Letter to Nancy Pelosi at page 1, available at <http://www.cbo.gov/publication/21351> (last visited October 22, 2018).+(last+visited+October+22,+2018).>Google Scholar
Congressional Budget Office Cost Estimate, H.R. 849 Protecting Seniors’ Access to Medicare Act (Oct. 27, 2017); Medicare Boards of Trustees, 2018 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 187 (June 5, 2018).Google Scholar
Medicare Boards of Trustees, 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 180 (July 22, 2015); Medicare Boards of Trustees, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds at 179 (July 13, 2017).Google Scholar
Please see, Majette, G.R., “The ACA's New Governing Architecture and Innovative State Delivery System Reform Initiatives” for an in-depth comparative analysis of Maryland's All Payer Model and the Massachusetts Chapter 224 — An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation (2012)(article on-file with the author).Google Scholar
Health Services Cost Review Commission, “All Payer Model Results, CY 2014–2017,” available at <http://www.hscrc.state.md.us/Documents/Modernization/Updated%20APM%20results%20through%20PY4.pdf> (last visited October 22, 2018).+(last+visited+October+22,+2018).>Google Scholar
Maryland Department of Health, The Maryland All-Payer Model Progression Plan: Update to the December 2016 Proposal to the Centers for Medicare and Medicaid Services (May 2018); Maryland Total Cost of Care Model State Agreement (July 9, 2018).Google Scholar
Massachusetts Health Policy Commission, “2017 Annual Health Care Cost Trends Report,” March 2018, at 12, 16.Google Scholar
82 Federal Register 57066 (December 1, 2017).Google Scholar