What does President Trump’s Medicare Executive Order mean for you?

You may have heard by now that last week President Trump signed an  Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors. The Executive Order (EO) directs various federal agencies, mainly the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), to take actions to strengthen Medicare fee for service (FFS) and Medicare Advantage (MA).

The EO is largely a response to Medicare for All proposals championed by Democrats. With the EO, the Trump administration believes it has strengthened the MA program, in contrast to the Medicare for All proposals.

Executive Orders are typically vague on policy specifics. Rather, they are intended to direct agencies to develop regulations to achieve the goals described in the EO. It is not clear if the agencies will issue a stand-alone regulation to address these issues or if the policies described in the EO will be folded into other regulations such as the Medicare Physician Fee Schedule.

The Advocacy Council has summarized the major topics addressed in the EO.

Reduce administrative burden

Within one year, HHS/CMS will issue regulations to eliminate administrative burdens on providers participating in the Medicare program. This includes burdensome billing requirements, conditions of participation requirements, supervision requirements, benefit definitions and Medicare licensure requirements that are more stringent than federal or state laws.

Reimbursement based on time spent with patient

The forthcoming regulation would also ensure that Medicare better reimburses specialists and primary care providers for time spent with patients.

Reimbursement parity for physician and nonphysician practitioners

The EO directs HHS/CMS to perform a review of regulations that create disparities in reimbursement between physicians and nonphysician practitioners. The EO also directs HHS/CMS to issue new regulations that would reimburse physician and non-physician clinicians based on the type of work performed rather than their occupation.

Market-based pricing in Medicare FFS

Within 180 days, HHS/CMS is directed to issue a report on recommended approaches to transition towards “true market-based pricing in the FFS Medicare program.” These approaches include shared savings and competitive bidding and use of MA rates as a benchmark for FFS rates.

Expand access to Medicare Medical Savings Accounts

CMS will issue regulations and guidance to improve access to Medicare Medical Savings Accounts, which is the Medicare version of a Health Savings Account linked to a high-deductible health plan.

Expand MA supplemental benefits and telehealth coverage

CMS is also required to promote expanded supplemental benefits and telehealth services in MA plans. This includes creating a payment model that “adjusts supplemental MA benefits to allow Medicare beneficiaries to share more directly in the savings from the program, including through cash or monetary rebates, thus creating more incentives to seek high-value care.”

Report on achieving greater MA-FFS payment parity

Within 180 days of the EO, HHS/CMS will issue a report identifying approaches to “modify Medicare FFS payments to more closely reflect the prices paid for services in MA and the commercial insurance market, to encourage more robust price competition, and otherwise to inject market pricing into Medicare FFS reimbursement.”

Network adequacy

Within one year, HHS will issue regulations to adjust MA network adequacy requirements to account for the competitiveness of the plan’s market. This will include whether the state has certificate-of-need  laws or other anticompetitive restrictions on health access.

Site neutrality

HHS/CMS will continue to pursue site-neutral payment policies.

Data transparency

Within one year, HHS/CMS will issue regulations to provide Medicare patients with quality and cost data. The purpose of improved data access is to help patients make informed decisions about the providers and health plans they select and to hold providers and plans accountable.

Program integrity

The EO directs HHS/CMS to take new regulatory actions to combat fraud, waste and abuse in the Medicare program. The EO does not specify any specific activities but does direct the agencies to use the latest technologies, such as artificial intelligence.

The Advocacy Council and College will continue to monitor and report on this as it moves forward.

Advocacy Issue: 
Billing, Coding & Payments