President Joe Biden, in his first 10 days after being inaugurated as the 46th president of the United States, issued approximately 40 executive orders, memoranda and presidential proclamations. Of these, 12 pertained to healthcare. His first executive orders on healthcare directed various government agencies to review policies associated with turning over marketplace enrollment functions to private entities and using Medicaid Section 1115 waivers to implement work requirements and block grants.
In addition, they focused on scrutinizing policies designed to make enrollment in Medicaid and coverage through the Affordable Care Act (ACA) more difficult and offer less financial assistance. Let’s take a look at the journey Biden’s administration kick-started this year on behalf of healthcare.
Early healthcare actions
Biden established a special enrollment period for the health insurance marketplace in the beginning of his presidency. Between February 15 and August 15, new enrollees had the opportunity to sign up, and individuals already enrolled had the option to update their information and change plans.
In March, it was announced by the Biden administration that the CMS Innovation Center (CMMI) paused some value-based reimbursement models, including the Geographic Direct Contracting Model (GDCM), Primary Care First Model’s Seriously Ill Population (SIP) option, and the Kidney Care Choices (KCC) Model. Only one month later, the Centers for Medicare & Medicaid Services (CMS) announced that it wasn’t soliciting any more applications for the Global and Professional Direct Contracting Models, which are scheduled to launch on January 1, 2022.
The GPDC Model includes innovative ideas from Medicare Advantage (MA) and private sector risk-sharing arrangements and was built on the Next General ACO Model to offer the next evolution of risk-sharing arrangements to produce value and high-quality healthcare.
Next Generation ACO Model extension nixed
Many healthcare industry experts were surprised when the Biden administration announced a few weeks ago that it wouldn’t extend the Next Generation Accountable Care Organization (ACO) Model, which is scheduled to expire at the end of 2021. The National Association of Accountable Care Organizations (NAACOS) stated that the extension of the Next Gen Model was a top advocacy priority for the organization and that it recommends the forming of “a permanent, Next Gen-like ACO model that provides a better bridge between MSSP Enhanced and the full capitation option under Direct Contracting.”
Clif Gaus, Sc.D., the president and CEO of NAACOS, explained that Next Generation ACOs have saved Medicare over $1 billion. These savings were compared to program benchmarks and netted $616 million to the Medicare Trust Fund after accounting for shared savings, shared losses, and discounts paid to CMS.
Although the Next Gen ACO Model won’t be extended, CMMI is giving those Next Gen ACOs that are eligible the option to participate in the Global and Professional Direct Contracting (GPDC) Model. The GPDC Model is also available to Next Gen ACOs that had already applied and deferred their participation. This leaves the Medicare Shared Savings Program (MSSP) as the only operational choice for new and NextGen ACOs that don’t qualify for direct contracting in 2022.
Since announcing earlier this year that it wasn’t soliciting any more applications for the Global and Professional Direct Contracting Models, CMS has since announced that it will let Next Gen ACOs apply to become Standard Direct Contracting Entities. However, any ACOs planning to remain in partial or full-risk models only have until June 14, 2021 to submit documents demonstrating they meet the requirements for participating in Medicare direct contracting.
Proposed FY 2022 budget healthcare initiatives
The transition to value-based care appears to have slowed down under the new administration, but that doesn’t mean government officials don’t have any new plans for the healthcare industry. On May 28, Biden released his proposed $6 trillion budget for fiscal year 2022, which includes the following healthcare initiatives:
- almost $100 billion to improve access to Department of Veterans Affairs (VA) healthcare, including $882 million for medical and prosthetic research to advance VA’s understanding of traumatic brain injury, the effects of toxic exposure on long-term health outcomes and the needs of disabled veterans
- close to $9 billion to ensure the Centers for Disease Control and Prevention (CDC) is ready for future public health crises
- over $150 million for CDC’s Social Determinants of Health program to support states and territories in improving health equity and data collection for racial and ethnic populations.
- roughly $6.5 billion for the Food & Drug Administration (FDA), including funds to address its critical health infrastructure needs and for food and medical product safety programs.
- more than $200 million to reduce maternal mortality and morbidity rates nationwide, bolster Maternal Mortality Review Committees, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program (CHIP) patients, implement implicit bias training for healthcare providers and create state pregnancy medical home programs
- approximately $6.5 billion to launch an Advanced Research Projects Agency for Health (ARPA-H), which would provide large increases in direct federal research spending on healthcare
- more than $10 billion in discretionary funding at the Department of Health and Human Services (HHS) to support research, prevention, treatment and recovery support services for patients with opioid use disorder
- roughly $670 million within HHS to help reduce new HIV cases while increasing access to treatment, expanding the use of pre-exposure prophylaxis and ensuring equitable access to services and supports.
- more than $2 billion for the Justice Department to address gun violence
- about $340 million for the Title X family planning grant program
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