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Commonwealth Fund Analyzes Medicare Flexibilities Granted During the Public Health Emergency

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This week, the Commonwealth Fund released a report that summarizes and analyzes the over 200 temporary legislative and regulatory changes that have been made to Medicare in response to the COVID-19 public health emergency. They also looked at the sub-regulatory guidance that the Centers of Medicare & Medicaid Services (CMS) has released to interpret these rules and to provide additional flexibility to providers and Medicare plans.

The article categorizes the changes under several themes and notes that most will expire or end without further action, as they are tied to the public health emergency period. The most prevalent types of changes are to the rules governing providers–altering who can bill Medicare (conditions of participation requirements); how they must bill and report (payment systems and quality programs); and rules about provider staffing (capacity and workforce). 

Some of the changes directly impact how people with Medicare experience their health care, while others are “invisible” to Medicare beneficiaries. The report summarizes each change along with anticipated or potential benefits and drawbacks–highlighting that even the most obvious and seemingly necessary changes could have negative effects, “[f]or example, even highly necessary and appropriate changes, like increased COVID-19 testing, come with potential drawbacks for beneficiaries, such as the risk of surprise billing and high cost-sharing amounts.” The report also notes that “it may be necessary to let certain temporary waivers expire, possibly even before conclusion of the public health emergency if the continued threat of possible patient harm outweighs the potential benefits of the policy waiver…For example, policymakers may need to significantly limit the duration of the waivers related to on-time preventive maintenance of dialysis machines and scheduled fire inspections.”

The authors also call for CMS and others to make use of the “unique opportunity” presented by these temporary and quickly implemented policy changes by closely studying their impact and evaluating continued or further changes considering the lessons learned. 

The Medicare Rights Center appreciates that some of the current flexibilities have helped keep people with Medicare, their families, and the health care workforce safe during the pandemic. As policymakers consider which rules may be appropriately continued as-is, we urge a deliberate and thoughtful decision-making process that allows time for proper data collection and evaluation, as well as for public input. Any longer-term or permanent changes must meaningfully center the unique needs of older adults and people with disabilities.

Medicare Rights shares the authors’ caution about some of the changes and urges policy makers to move slowly when it comes to making the changes permanent once the pandemic is contained.

See the full report here: https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/regulatory-changes-medicare-response-covid-19.

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