The House and Senate will be in session next week.

Congressional State of Play. Congress must pass a short-term stop-gap funding bill by December 20th to avoid a government shutdown. Congressional leaders in the House and Senate have been negotiating the parameters of a three-month funding bill and are considering attaching a package of additional health care policies. Policies being considered include an extension of telehealth flexibilities, a physician pay adjustment to address the impending rate cut, and funding for community health centers (CHCs). Negotiations remain fluid, so the extent to which policies may be included and the duration of any extenders remains to be seen. A4H continues to push Congress to mitigate physician pay cuts and include the advanced alternative payment model bonus extension in any end of year package.

DOGE Finds Support in Congress. President-elect Trump’s Department of Government Efficiency (DOGE), headed by Elon Musk and Vivek Ramaswamy, has found bipartisan support from Members of Congress. In the last few weeks, the DOGE leaders met with lawmakers on the Hill to discuss their plans. In a show of support, Sen. Joni Ernst (R-IA) and Reps. Arron Bean (R-FL), and Pete Session (R-TX) have formed a Delivering Outstanding Government Efficiency (DOGE) Caucus. DOGE is charged with recommending ways to cut wasteful programs, identify excess regulations, and restructure federal agencies to reduce government expenditures. In the health space, DOGE has signaled an interest in looking more closely at Medicare fraud/abuse, unused COVID-19 funding, and intramural research grants, to name a few.

CMS Innovation Center Publishes Biennial Report to Congress. The CMS Innovation Center (CMMI) published its biennial Report to Congress covering activities in fiscal years (FY) 2023 and 2024. CMS estimates that 57 million beneficiaries were or will soon be served by the 192,000 providers and plans participating in one of the 37 CMMI models and initiatives in FY 2023 and FY 2024. The first strategic goal discussed in the report focuses on driving accountable care, under which CMS highlights accomplishments in five models: ACO REACH, Making Care Primary (MCP), ACO Primary Care Flex (ACO PC Flex), Enhancing Oncology Model (EOM), and the ACO Investment Model as part of MSSP. The report does not appear to provide new information about evaluation for specific models. A4H looks forward to continuing to work with CMMI to leverage and accelerate the growth of accountable care through model development.

CMS Finalizes Kidney Transplant Model. CMS issued the final rule on the Increasing Organ Transplant Access (IOTA) Model. The IOTA Model is a six-year mandatory model utilizing a two-sided risk arrangement designed to increase access to kidney transplants, improve the quality of care for people seeking kidney transplants, and spur innovation toward value-based care. The model’s participants include 103 kidney transplant hospitals in half of the nation’s donation service areas. The final rule on the model included several significant changes, including increasing the upside risk payment from $8,000 to $15,000 per Medicare kidney transplant, adjusting the transplant target to reflect the average number of transplants during the baseline year rather than the highest count, removing three measures from the post-transplant outcomes (“quality”) portion of the performance assessment, and removing the health equity payment adjustment and allowing the health equity plans to be voluntary, among other changes.

Two Drug Manufacturers Join Cell and Gene Therapy Model for Sickle Cell Disease. Vertex and Bluebird Bio have agreed to participate in the CMS Innovation Center’s Cell and Gene Therapy (CGT) Access Model, testing outcomes-based agreements (OBAs) for cell and gene therapies for Medicaid patients with sickle cell disease. The OBAs will tie pricing for the CGTs to whether the treatment improves patients’ health outcomes. CMS says the manufacturer’s participation in the model will allow patients to access potentially curative therapies for sickle cell disease that would otherwise be inaccessible due to the high costs of the therapies. The state participant application for the CGT Access Model will remain open this month through February 2025. States can also apply for optional model funding through a separate notice of funding opportunity. We continue to work with CMS on value-based model development that reduces costs while improving patient health.

Double Click on Accountable Care Recap. On December 12th, A4H brought together policy professionals to hear presentations on the 2025 accountable care agenda, Medicare Advantage policy concepts, legislation impacting individuals dually eligible for Medicare and Medicaid, and the future of alternative payment models and the CMS Innovation Center. During the event, A4H CEO Mara McDermott provided an update on the accountable care agenda for 2025. Joe Albanese with Paragon Health Institute discussed Medicare Advantage policy in 2025. Josh Trent, with Leavitt Partners, discussed legislation impacting individuals who are dually eligible for Medicare and Medicaid. Stay tuned for an update on our next Double Click event.

Register for A4H @ Health Care Value Week. Join A4H on February 25th for an in-person event in Washington, DC, in conjunction with Health Care Value Week. The event will bring together organizations, stakeholders, and policymakers to discuss accountable care successes and the work ahead. Sessions will include Congressional, community, and provider perspectives on accountable care and the outlook for the future of healthcare delivery reform. You can see a list of confirmed speakers here. Register here and stay tuned for additional programming updates.