Prospective CMS administrator’s confirmation hearing highlights Congress’s desire to expand telehealth coverage

• In a confirmation hearing for prospective CMS Administrator Chiquita Brooks-LaSure, various members of the Senate Finance Committee expressed their hope to implement a permanent expansion of Medicare telehealth coverage.
• Deferred care, 340B drug pricing and the area wage index were among the other topics that came up during the hearing.
• As of April 21, the confirmation of Brooks-LaSure was on hold due to a disagreement between a Republican senator and the Biden administration.

Telehealth will be a key focus area in Medicare and Medicaid policy during the Biden administration if the confirmation hearing for Chiquita Brooks-LaSure, the nominee for CMS administrator, was any indication.

Appearing before the Senate Finance Committee on April 15, Brooks-LaSure fielded questions about telehealth from several senators.

Brooks-LaSure had been expected to be confirmed without controversy, but the process has been put on hold by Sen. John Cornyn (R-Texas). Cornyn used a procedural maneuver in response, he said, to the Biden administration’s recent refusal to extend a Medicaid waiver in his state.

Telehealth under the microscope

The federal government provided waivers authorizing expanded Medicare telehealth coverage in response to the COVID-19 pandemic. Now Congress is considering whether to make those changes permanent.

Said Sen. Ron Wyden (D-Ore.), chairman of the Finance Committee, “As a result of the pandemic, we’ve removed some of the roadblocks for people to actually get to a telehealth provider. We’re going to have to make those kinds of changes permanent in addition to working on the critical reimbursement issue.”

Sen. Maria Cantwell (D-Wash.) asked Brooks-LaSure where telehealth reimbursement should end up after the pandemic subsides.

“There are certainly safeguards we need from a program integrity perspective to make sure we know that services are being delivered, but it’s one we’ll have to titrate to figure out,” responded Brooks-LaSure, who appeared at the hearing alongside Andrea Palm, the nominee to become HHS deputy secretary.

Cantwell said she considered that answer “a little bit of a punt” coming from someone with Brooks-LaSure’s industry knowledge and expertise.

Added Cantwell, “I’m good with examining the savings, but this is just a new efficiency discovered in the Information Age, with COVID being the thing that prompted us here. My guess is we’re going to see huge savings. I would say you’re at or close to the reimbursement rate that we’re at today.”

Cantwell noted that the Senate Commerce, Science and Transportation Committee is working on a bill to expand broadband access for care delivery in remote areas of the country.

“It would be foolish not to try to pair the broadband investment with the right reimbursement rate,” she said. “Otherwise we would be making this investment and giving us access but not having the utilization because physicians or the system would continue to defer to seeing people in person.”

Sen. Mike Crapo (R-Idaho), Finance Committee ranking member, said telehealth represents an area of potentially bipartisan agreement.

Audio-only visits also need to be incorporated in telehealth payment policy, said Sen. Catherine Cortez Masto (D-Nev.).

Other policy areas of interest

The impact of deferred care as seen during the pandemic came up in questioning by Sen. Robert Menendez (D-N.J.), who cited a study showing primary care visits declined by 21% in Q2 2020 compared with the previous two years.

“I’m deeply concerned that delays in cancer and other screenings will translate into an increase in advanced disease cases and ultimately death as a result of millions of Americans avoiding routine preventive care in the past year,” Menendez said. He added that such trends would disproportionately affect Black and Latino communities “who already have less likely access to preventive care.”  

As fear of exposure to the novel coronavirus subsides, cost may remain a concern for people considering whether to seek care. Brooks-LaSure noted that the Affordable Care Act made many preventive services free, and “CMS needs to continue to educate providers, beneficiaries, patients and families and work with stakeholders and trusted partners to encourage people to get preventive care.”

Topics that did not arise during the hearing included price transparency and the future of the Medicare Hospital Insurance Trust Fund, which is projected to become insolvent in the next three to five years.

Various other topics that would affect the delivery and financing of healthcare were discussed. Some of those were:

Surprise billing. Brooks-LaSure will be charged with implementing the No Surprises Act during the second half of 2021. “I know we’re on a very tight timeline,” she said, pledging to act expeditiously to enact regulations through the rulemaking process.

Dual-eligibles. Sen. Bill Cassidy (R-La.) said he hopes Brooks-LaSure will work to improve coordination of services for people who are eligible for both Medicare and Medicaid.

Brooks-LaSure responded, “There’s still a need to coordinate better on what we see in long-term care and nursing homes, and hospitalization. Some of that is going to take legislation and really thinking about how we treat people on the continuum. Particularly in assisted living [and the] PACE program, I think there’s more we can do to encourage that kind of coordination.”

340B program. In a question to Palm, Sen. John Thune (R-S.D.) described the 340B Drug Pricing Program as having been “dysfunctional for some time now. We’ve heard concerns recently from covered entities in my state about actions taken by manufacturers not reimbursing contract pharmacies all of a sudden, and now PBMs [pharmacy benefit managers] imposing conditions on hospitals in order [for hospitals] to get reimbursed.”

Palm, who would help oversee the 340B program as administered by the Health Resources and Services Administration, committed to working to ensure “that the oversight and the implementation are appropriate so that we really are implementing legislative intent and getting to our safety net providers and low-income communities the access that they need.”

Prescription drug prices: Democrats and Republicans both hope Brooks-LaSure and Palm can address the price of prescription drugs, but the parties have differing visions for how to do it.

Wyden wants to authorize Medicare to negotiate drug prices with manufacturers. He also said manufacturers should be at risk of losing federal subsidies if they engage in price gouging.

Crapo said regulations should not stifle innovation in the pharmaceutical industry. “I strongly agree with my colleagues that this innovation is only valuable if patients can afford it,” he said. “We should establish an out-of-pocket spending cap and reform Medicare Part D with the market-based principles of competition and transparency in mind.”

Medicare wage index. Sen. Mark Warner (D-Va.) got a commitment from Brooks-LaSure to help implement prospective legislation to bolster payments to rural hospitals. Warner’s bill would establish a national wage index of 0.85, which he said would increase Medicare payments for rural hospitals in 22 states.

“It’s no coincidence that the vast majority of [rural] hospital closures occurred in areas with the lowest Medicare area wage index rates,” Warner said.