B-TAC

The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

Each week, C-TAC compiles the latest legislative and regulatory updates affecting the serious illness care field, combined with insider analysis from our policy experts. Here’s what you need to know for the week ahead:


Biden Administration Names Acting CMS and HHS Heads

The Biden Administration has named Liz Richter has been named the Acting Administrator of the Centers for Medicare & Medicaid Services and Norris Cochran as acting Secretary of the U.S. Department of Health and Human Services.

Richter has served at CMS since 1990, most recently as as the deputy center director for the Center for Medicare. Cochran was previously the HHS Assistant Secretary of Budget and served as Acting Secretary in early 2017 while former HHS Secretary Tom Price was confirmed in the Senate.

C-TAC looks forward to working with these leaders in support of people with serious illness and their families as the permanent nominees for these positions work their way through the Senate confirmation process. To learn more, click here.


Congressional Advisory Group Recommends Reducing Hospice Payments

The Medicare Payment Advisory Commission (MedPAC) voted unanimously on January 14th to eliminate the update to the Fiscal Year 2021 Medicare base payment rates for hospice for Fiscal Year 2022 and to cut by 20% the hospice aggregate cap amount. The payment “cap” is the upper limit to the amount of funds a hospice can collect from Medicare in a single year. If a hospice exceeds the payment cap, it must refund that amount to CMS. For Fiscal Year 2021, the hospice cap is $30, 684 per patient (not wage adjusted). About 16% of hospices exceeded the cap in 2019. According to MedPAC, the proposed cuts to the payment cap are designed to target hospice providers that see longer lengths of stay and high margins, improve equity of the payment cap among different types of providers, and generate cost savings for taxpayers and the Medicare Part A Trust Fund. It is important to remember that Congress is not obligated to adopt MedPAC recommendations, and they historically have not done so for many of the group’s hospice payment recommendations.

While C-TAC supports payment policy changes that address the structural challenges that disadvantage smaller, community-based providers, we encourage Congress to ensure payment modifications do not inadvertently result in decreased access to hospice care for patients and families, especially in rural and underserved areas.


CMS Releases Request for Applications (RFA) for Geographic Direct Contracting Model

On January 15, CMS released the Request for Applications (RFA) for the Geographic Direct Contracting (DC) Model (“Geo”). CMS also released an accompanying Model Data Book and a Proposed Discount Tool (both in XLS formats). The Geo model’s design parameters are unique compared to the current DC participation options available, including the requirement that all Geo participants in one of the target geographies will be clinically and financially responsible for every Medicare fee-for-service beneficiary in that geography. The RFA provides further model details, including eligibility and participation requirements, design elements such as beneficiary alignment and outreach requirements, and application questions, scoring, and selection processes.

The Geo Model will be tested over a six-year period in four to ten regions and will include two three-year Model Agreement periods, the first of which starts on January 1, 2022, and the second of which starts on January 1, 2025. CMS intends to accept applications from March 1 – April 2, 2021 via an online portal. Further details on the application process and additional model information will likely be made available in the coming month. C-TAC will continue to monitor the Geo model to identify opportunities and potential challenges for our members and those in the broader serious illness care field.


House Ways & Means Committee Releases Report and Legislative Framework to Address Inequities

The U.S. Congressional House Ways and Means Committee released a report titled, Something Must Change: Inequities in U.S. Policy and Society, which outlines the correlations between federal policies and inequities in the health care system and economy. The Committee also released a corresponding legislative framework for how it will address the role that racism, ableism, and other social, structural, and political determinants have in perpetuating health and economic inequity in the United States. The Committee’s legislative framework consists of specific policy priorities to address current inequities in health care and the workforce, such as:

  • Adaptable, Accessible Technologies and Modernized Infrastructure
  • Appropriate, Adequate, and Trusted Workforce
  • Affordable, Comprehensive, and Accessible Health Care
  • Support to State and Local Governments for Maximum Efficiency of Resources

C-TAC is committed to advancing public policies that address the health disparities that the most underserved seriously-ill patients and families experience. We are heartened to see this important congressional committee lay out a vision for how it can support the goal of reducing health inequities, and we will work with committee to staff to explore our how our members and partners can contribute to making progress on these ideas.


CMS Releases Pandemic Plan to Help Guide Response to Future Viruses

On January 12, CMS released the CMS Pandemic Plan (“The Plan”) that details the response the agency engaged in to support the country’s healthcare system and beneficiaries throughout the ongoing COVID-19 pandemic. The document outlines CMS’s process for implementing waivers and flexibilities to support stakeholders and ensure continued access to care for beneficiaries. It also details how CMS aimed to provide regulatory relief to frontline providers, including waivers important to serious illness care providers such as expanded telehealth flexibilities and expanded Hospital without Walls and Hospital at Home initiatives.

C-TAC hopes that The Plan can support future administrations should another pandemic emerge, and ensure the protection of equitable access to high quality health care for the seriously ill and underserved populations.

To learn more about C-TAC’s policy activities and key priorities, visit our Policy & Advocacy page.

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