Chiquita Brooks-Lasure faced the Senate Finance Committee Thursday for a confirmation hearing for her nomination to serve as the administrator of the Centers for Medicare & Medicaid Services (CMS).
Brooks-LaSure, who faced senate questioning alongside Andrea Palm, who is being considered to serve as Department of Health and Human Services (HHS) deputy secretary, was questioned about several policy areas that she will oversee if she is confirmed. These include the 340B drug discount program, dual-eligible care coordination and telehealth.
The hearing didn't highlight any major opposition from Republicans to her nomination, likely signaling her confirmation as the head of CMS.
Here are three takeaways from the confirmation hearing:
Making telehealth flexibility permanent
Several senators highlighted the need to ensure that the telehealth boom that started during the pandemic continued. Brooks-LaSure said that she wants to examine what CMS’ authority is to extend the flexibilities that are set to expire at the end of the public health emergency period.
But Brooks-LaSure demurred when asked by Sen. Maria Cantwell, D-Washington, what the reimbursement rate should be for telehealth, a major question mark.
Currently, Medicare pays the same rate for telehealth as an in-person visit. Former CMS Administrator Seema Verma wrote in a Health Affairs blog post in July that further research may be needed to determine the “level resources involved in telehealth visits” and whether the rates need to be adjusted.
Brooks-LaSure told Cantwell there are “safeguards” that are needed from a program integrity perspective to ensure CMS knows “that services are being delivered. It is one that we will have it titrate and figure out.” Cantell said that she considered the answer “a little bit of a punt.”
Improving dual-eligible care coordination
Sen. Bill Cassidy, R-Louisiana, was concerned about how to improve outcomes for beneficiaries enrolled in Medicare and Medicaid.
“We both know we spend a lot of money on duals, and we get miserable outcomes,” he said.
One of the issues is that it is difficult for aligning incentives for both state and federal governments, Cassidy said. He asked what lessons have been learned from the Affordable Care Act’s (ACA's) effort to improve dual-eligible care. She responded that there needs to be better coordination between long-term care, nursing homes and hospitals.
“Some of that is going to take legislation and really thinking about how do we treat people in the continuum,” she said.
Brooks-LaSure mentioned other programs such as assisted living PACE programs, which aim to treat beneficiaries the same way as if they were in a home or an assisted living facility.
Flexibility and certainty for states applying for waivers
Brooks-LaSure said granting waivers to state for Medicaid or ACA changes requires a “great deal of responsibility,” and she wants states to understand what rules are to have a consistent guidance. But she will likely be scrutinized by Republicans on how she handles the controversial Trump-era work requirements program.
CMS has moved to withdraw the waivers that the Trump administration approved for several states. Sen. Mike Crapo, R-Idaho, asked Brooks-LaSure if pulling approved Medicaid waivers “immediately following an election" sends the wrong message to states.
“I do a lot of work with states and understand how much they want certainty from the federal government,” said Brooks-LaSure, who formerly served in CMS under the Obama administration. “That is something if confirmed I will really work to make sure that states understand certain decisions and are part of the decision making.”