CMS wants 'new direction' for its innovation center, but lawmakers say it is an attempt to undermine Medicare

The Centers for Medicare and Medicaid Services wants to take its innovation center in a "new direction" and is seeking feedback on payment models it has already developed. 

CMS announced that it is seeking information so that the Center for Medicare and Medicaid Innovation can test payment models in eight areas: 

  1. Increased participation in the advanced alternative payment models developed by the center 
  2. Market-based or consumer-directed models 
  3. Payment models based on physician specialty 
  4. Prescription drug models 
  5. Models to innovate Medicare Advantage payments 
  6. Local and state-based models, including those through Medicaid 
  7. Models in mental and behavioral health 
  8. Program integrity 

CMS will accept comments and feedback through Nov. 20. 

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CMS Administrator Seema Verma said in an op-ed published in The Wall Street Journal that the agency will look at all payment models that have come out of CMMI to determine what works and what doesn't. 

"We will move away from the assumption that Washington can engineer a more efficient healthcare system from afar—that we should specify the processes healthcare providers are required to follow," Verma said. 

She said the complexity of some of the new payment models may have contributed to consolidation in the healthcare industry, limiting patient choice. However, she emphasized the need for the healthcare system to continue its transition from a fee-for-service model to value-based care

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The full request for information document (PDF) hints at notable changes to Medicare. Pilot programs mentioned in the document include creating incentives to encourage more patients to sign up for Medicare Advantage plans. 

"CMS is potentially interested in a demonstration in Medicare Advantage that incentivizes MA plans to compete for beneficiaries, including those beneficiaries currently in Medicare fee-for-service, based on quality and cost in a transparent manner," the document reads. 

But the announcement ruffled the feathers of at least two members of the House of Representatives. In a joint statement, Ways and Means Committee Ranking Member Richard Neal (D-Mass.) and Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.), said the administration appears to have "no vision beyond undermining Medicare."

Furthermore, they said, Health and Human Services Secretary Tom Price is soliciting comments for demonstrations that could increase costs and loosen protections for elderly Medicare patients, including allowing unlimited charges for medical services and issuing vouchers for the program. "This is clearly the wrong direction and we urge CMS to continue the goals of delivery system reform that prioritizes value for beneficiaries, not special interests," they wrote.