Trump signs executive order aimed at Medicare in face of Medicare for All proposals

President Donald Trump signed an executive order to give Medicare Advantage (MA) plans more flexibility and reduce regulations for certain medical professionals.

Trump delivered speech Thursday at The Villages retirement community in Florida to outline the order, which directs the Department of Health and Human Services (HHS) to develop regulations that would give MA beneficiaries more diverse options in their plans. The executive order is part of an effort by the Trump administration to contrast Medicare with single-payer proposals such as “Medicare for All.”

“Today’s executive order reflects importance on protecting what works on our system and fixing what is broken,” HHS Secretary Alex Azar said on a call with reporters previewing the order.

Azar said part of the order calls for HHS to propose reforms to Medicare that enable providers to practice “at the top of their licensure.” He said there are “artificial restraints” that prevent nurse practitioners and physician assistants from providing care they are licensed for and that the agency will pursue regulations to loosen such restraints.

HHS will explore regulations that would reimburse non-physician professionals such as physician assistants the same as clinicians for certain services.  The goal is to ensure that items and services are "appropriately reimbursed in accordance with the work performed rather than the clinician's occupation," the order said.

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The order will also call for a payment model that adjusts supplemental MA benefits to give beneficiaries capped or monetary rebates for seeking high-value care.

HHS must also submit a report within 180 days to look at how to modify fee-for-service payments to more "closely reflect the prices paid for services in MA and the private commercial insurance market, to encourage more robust price competition and otherwise to inject market pricing into Medicare fee-for-service reimbursement," the order said.

It also seeks to ensure that the fee-for-service part of Medicare, where a majority of beneficiaries get care, is not disadvantaged compared to MA plans.

“The executive order commissions us to look at all regulations, guidance and steering fee for service,” Azar said. “How does the enrollment process work when people come in?”

He added that the order will also deal with improving access through network adequacy in MA plans. Within one year, HHS must propose regulations that adjust the network adequacy requirements for MA plans to factor in access to telehealth services. 

MA plans will be able to provide telehealth as a supplemental benefit starting in 2020. The order aims to encourage adoption of telehealth technologies by streamlining approval of new advances in telehealth services and breakthrough medical devices. 

HHS must also take to account the competitiveness of the health market in the states where MA plans operate when determining network adequacy, the order said. For instance, HHS must factor in if a state has a certificate-of-need law that is necessary for the construction of health facilities in 34 states. 

The order says that within one year HHS will propose regulations to encourage innovative MA benefit structures and plan designs.  The executive order comes as the Trump administration has touted lower premiums on MA. Premiums for 2020 MA plans are expected to decline in 2020 by 14% compared with 2019.

The average premium is likely to be the lowest since 2007, the Centers for Medicare & Medicaid Services has said.