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Policy Experts Review the Latest Regulatory and Legislative Updates Around Serious Illness

By: Joanna George, C-TAC Policy Intern

On August 4th, 2021 C-TAC’s team of policy experts were joined by Rachel Fybel, Legislative Assistant to Senator Sheldon Whitehouse (D-RI), to provide the latest regulatory and legislative policy updates impacting our field.  Key insights were provided on the political landscape around serious illness, regulatory progress around care models, and C-TAC’s policy & advocacy priorities.

The Political Landscape Around Care for Serious Illness

The Biden-Harris administration has made clear the intention to strengthen Medicaid and Medicare. Proposed spending, legislation, and regulatory changes have positive implications for people living with serious illness.

  • Proposed spending to advance health equity, enhance the caregiving infrastructure, and increase community-based services in the American Jobs Plan and American Families Plan.
  • Support CMS’s movement toward value-based care. 
  • Strategic analysis by new CMS leadership outlined in the agency’s annual report to Congress. 
  • Changes in leadership at CMS and CMMI have created new opportunities to remain engaged through proposals like Medicare Care Choices Model 2.0 and Primary Care First, a population demo that is being evaluated for serious illness care.
  • CMS is currently evaluating many of the pandemic waivers to assess the benefits of long-term implementation for providers and patients.  

Progress continues to be made in Congress as key legislation to improve the lives of people living with serious illness is anticipated 

  • The Biden-Harris RY 2022 Budget proposal passed seven of twelve appropriations, including Labor-HHS-Education related agencies and Older Americans Act programs.
  • A Care Infrastructure package is anticipated, which incorporates a drug pricing element to assist with paying for this measure. 
  • Upcoming Senate action through reconciliation includes provisions modeled after the American Jobs Plan and the American Families Plan that align with C-TAC priorities, such as enhanced Medicaid funding for home & community-based services and increased financial support for home health workers. 

Regulatory Progress on Care Models for Serious Illness : 

Our policy team provides comments to executive agencies on proposed rules impacting the field of care for serious illness. These comments are reviewed by the respective agency and considered when finalizing the proposed rule. Our team provided updates on C-TAC’s commentary during the webinar: 

  • C-TAC supports the initiative to increase access to health information in the CMS HIPAA Privacy Rule, and encourages facilitating value-based care by modifying provisions limiting care coordination and case management communication. While the rule allows more community organizations to access PHI, C-TAC expressed concern as this rule does not address the need for financial or capital investment in the required information management systems.  
  • C-TAC submitted comments for the Hospice Proposed Rule and expressed support for permanently extending waivers granted during the COVID19 pandemic and postponing proposed changes to the reporting program. 

The onset of the COVID19 pandemic and corresponding barriers to in-person appointments and interventions revealed the limitations of the existing Medicare fee-for-service system, encouraging the transition towards telehealth and value-based care. Efforts are underway to enhance the system and address key issues, such as equity through the proposed ESRD rule which incentivizes providers to care for dual eligible patients and those from lower income communities.  

C-TAC supports the following changes to the current model: 

  • Transition towards value-based care.
  • Expansion of quality measures while acknowledging the risk for smaller organizations who might struggle to meet the same metrics for reimbursement
  • Risk adjustment within payment systems to account for socially and systemically-derived risk factors.

C-TAC is currently developing a set of core principles to evaluate models which provide care for those living with serious illness. 

C-TAC Policy & Advocacy Priorities

C-TAC’s 2021 policy agenda is bipartisan, bicameral, data-driven and seeks opportunities for involvement within overarching health issues. Particular priorities include increasing access to  advance care planning, community-based services, and support for caregivers.

C-TAC is closely monitoring key legislation that carry implications for our field, including: 

  • Expanding Access to Palliative Care Act (S.2565), 
  • The Patient Choice and Quality Care Act of 2017 (S.1334/H.R.2797), 
  • The Removing Barriers to Person-Centered Care Act of 2019 (S.829), 
  • Palliative Care and Hospice Education and Training, (PCHETA) Act (S.2080/H.R.647), 
  • The Compassionate Care Act of 2020 (S.4945), and 
  • Medicare Choices Empowerment and Protection Act (S. 618)

Current advocacy efforts include efforts to enhance end-of-life care, including permitting concurrent hospice and curative care, extending home health services to non-homebound patients, implementing a demonstration model that resembles legislation in the Removing Barriers Act, and building on the Cares Act by allowing Nurse Practitioners to sign home health and hospice care plans and certify patients for hospice benefit. To view C-TAC’s policy update webinar or learn more about C-TAC’s 2021 policy agenda, visit our policy & advocacy web page here.

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