11 Feb HCTTF Letter Opposing H.R. 5741
The Health Care Transformation Task Force wrote to express opposition to H.R. 5741. In sum, the bill goes further than necessary to address legitimate concerns, will significantly hamper innovation through added administrative burden, and will give stakeholders new tools to slow innovation based on personal interests. As a result, the opportunities for physicians to participate in advanced alternate payment models (Advanced APMs) will be constrained, thereby slowing momentum toward a more robust value-based payment and care delivery system.
While introduced under the pretext of strengthening innovation and transparency, this legislation would impose new procedures and administrative burden on the Center for Medicare & Medicaid Innovation (CMMI or Innovation Center) that would effectively grind Medicare and Medicaid innovation to a halt. While HCTTF supports greater transparency and public input around CMMI’s initiatives, this bill goes too far by replacing CMMI innovation with CMMI paperwork through new, overly bureaucratic oversight by the legislative and judicial branches.
This bill also provides tools for certain stakeholders to use political means to attempt to delay innovations they find undesirable, with the opportunity to do so being available at every stage of model design, development, modification or expansion. This approach represents a fundamental change to CMMI’s authority, going well beyond the desirable objective of greater public input and CMMI transparency. Thus, HCTTF members believe that H.R. 5741 is a step in the wrong direction for value-based transformation.
Provisions of H.R. 5741 cause HCTTF significant concern
CMMI would be required to transmit a proposal to Congress for the “testing, expansion, or modification” of every alternate payment model at every stage of development. The administrative slowdown would be a net negative for advancing value-based payment models and would adversely affect the scope and breadth of CMMI’s model portfolio.
The proposed legislation would place significant limits on the scope and duration of CMMI models.
H.R. 5741 would institute an avenue for judicial review of CMMI’s decisions on design parameters and model expansion.
HCTTF is a longstanding supporter of CMMI. By testing over 40 alternate payment models, the Innovation Center has been a major catalyst in the promotion and advancement of value-based payment and care delivery reform across the United States, which has also helped spur momentum in private sector transformation. CMMI’s ability to iterate upon and expand successful APMs is an important tool that allows for timely and responsive modernization of government health care programs. The Innovation Center’s unique authority is widely viewed as a distinct and welcomed improvement over the prior cumbersome Medicare demonstrations process.
H.R. 5741 includes policy proposals with which the HCTTF agrees, including refinements to address the challenging issues around overlapping value-based payment models. However, the concerns expressed above outweigh the benefits, especially considering HCTTF members would prefer to see more models qualify for expansion and made to be permanent offerings in the Medicare program. Thus, we oppose H.R. 5741 in its current form. We welcome the opportunity to work with Congress on an approach that better balances the critical issues in play regarding the future of CMMI.