Republican Study Committee Meets with Paragon on Potential Health Package. Last week, the Republican Study Committee (RSC) met with Paragon Health Institute to discuss the potential for a bipartisan healthcare package this fall. Discussion included consideration of a scaled-back extension of Affordable Care Act (ACA) enhanced premium tax credits and Medicare Advantage (MA) reform, as well as other topics that have traditionally garnered interest from lawmakers across the aisle, including pharmacy benefit manager reform, 340B program changes, and site-neutral payment policies. There are several expiring health provisions and policies, like telehealth flexibilities, funding for Community Health Centers, and a delay of Medicaid Disproportionate Share Hospital (DSH) cuts, that are likely to create the foundation of a health package that could be attached to a September 30 funding bill or other must-pass legislation this fall. A4H will continue to provide updates on the government funding situation and the make-up of a potential health package as negotiations continue.

CMS Now Accepting Submissions for Medicare Fraud “Chili Cook-Off.” Starting this week, CMS began to accept submissions for a new challenge to test explainable machine learning (ML) tools for identifying fraud based on Medicare fee-for-service (FFS) data. The challenge, called the “Crushing Fraud Chili Cook-Off Competition,” will consist of two phases: a white-paper submissions period, from which CMS will select ten finalists, and a testing phase, where the finalists will be given access to a subset of Medicare FFS claims data to test their proposals. White papers will be accepted until September 19, and the testing phase of the Cook-Off will begin on October 31. The overall goal of the Cook-Off is to develop explainable artificial intelligence and ML tools capable of detecting trends in claims data, which can be translated into novel indicators of fraud and reducing labor-intensive fraud prevention and response processes.

HHS and CMS Request Nominations for a New Health Care Advisory Committee. The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) are accepting nominations to form a Health Care Advisory Committee that will be charged with restoring patient-centered care, cut waste, reduce paperwork, expand preventive care, and modernize CMS programs. Nominations must be submitted within 30 days of the publication date in the Federal Register and members will be selected later this year.

CMS Offers More Detail on WISeR Amid Lawmaker Concerns. CMS published a new Frequently Asked Questions (FAQ) document on the Wasteful and Inappropriate Service Reduction (WISeR) Model, which would leverage enhanced technologies to ensure timely and appropriate Medicare payment. The new FAQ reiterates how the model is designed to protect patients from unnecessary procedures, leverage technology to streamline pre-service reviews, and safeguard against inappropriate denials of care. The FAQ was published shortly after CMS received a letter signed by 17 House Democrats, which expresses concern that WISeR will limit access to care, increase administrative burden on providers, and create incentives to value profit over patient welfare.

New A4H Issue Brief Calls for CMS to Finalize Skin Substitute Proposal in Medicare PFS Rule. Medicare spending on skin substitutes has increased 40 fold over the last five years and the stories of patient experiences are astonishing. A4H released a new issue brief highlighting the problems for patients, ACOs and Medicare, and calling on CMS to finalize its proposed reimbursement changes in the Medicare Physician Fee Schedule proposed rule. A4H encourages stakeholders to submit formal comments to CMS in support of this proposal and we continue to weigh in with Congress on the importance of finalizing this change.

MedPAC Commissioner Highlights “Priorities for Success” For CMMI. Current MedPAC Commissioner Dr. Joshua M. Liao outlined three ways the Center for Medicare and Medicaid Innovation (CMMI) can execute on its Make America Healthy Again Strategy in a new Health Affairs article. Dr. Liao identified priorities aligned with CMMI’s stated goals of increasing patient engagement, leveraging data and technology, and protecting taxpayer investment. Specifically, Dr. Liao recommended that CMMI consider improving patient engagement and influencing behavior change with non-financial incentives like gamification and social influence; design reimbursement strategies for new technology to encourage adoption of novel tools; and address systemic drivers of fraud, waste, and abuse beyond CMMI’s programs and models to ensure good stewardship of taxpayer investment.

Article Highlights Opportunities to Improve ACPT. Authors Michael Chernew and J. Michael McWilliams published a piece on the Accountable Care Prospective Trend (ACPT) in Health Affairs. It makes the case for administrative benchmarks and recommends four ways to improve the ACPT: 1) establish tighter guardrails that loosen over time; 2) sunset cohort-specific ACPTs by setting a single ACPT for each calendar year; 3) set the ACPT in advance; and 4) adjust the ACPT for price, major new technologies, and policy changes.

Congressional Hill Briefing on Kidney Care, October 21: Join A4H and C-TAC for a discussion with experts in health care, policy, and patient advocacy for a briefing on Improving Care for Patients with Kidney disease. The meeting will take place at the Rayburn Office Building, Room 2060 from 12pm to 1pm. Register here.

Virtual Value-Based Payment Summit, September 3-5: Register for this online event that will bring together CMS leaders, organizations, stakeholders, and policymakers to discuss value-based care initiatives. Confirmed speakers are listed here.