How to Assess the Future of Emergency, COVID-19 Medicare Policies

Congress and the Biden administration will have to determine which emergency, COVID-19 Medicare policies should be made permanent or be extended, according to a recent Commonwealth Fund study, and payers should be prepared for the process.

The researchers analyzed the coronavirus-related regulatory shifts between January 1, 2020 and January 8, 2021.

There were 244 coronavirus-related regulatory changes as of January 8, 2021, the researchers found. Of these, 11 percent have either been expanded or made permanent and two regulations have been removed.

However, that still leaves over 200 coronavirus-related Medicare regulatory measures with unresolved futures.

“To date, the Centers for Medicare and Medicaid Services (CMS) has not issued a public plan or statement for how it plans to extend or phase out most of these policies,” shared the study which was published in late May 2021.

These temporary measures were relevant to payers during the crisis and the regulations could continue to make an impact on the insurance industry if made permanent.

In order to determine whether or not Congress will solidify these regulations, policymakers will need data on the downstream effects.

There are a couple of ways in which lawmakers and payers can assess the effects of these policies. CMS is already conducting demonstrations through the CMS Innovation Center which may model, on a smaller scale, the impacts of coronavirus-era policies. 

Medicare Advantage plans also provide key data points as they increasingly incorporate the flexibilities that CMS has offered.

The researchers suggested that CMS release the results of the demonstrations and Medicare Advantage plans’ efforts in order to inform the upcoming regulatory decisions about the future of coronavirus-era Medicare waivers.

“CMS has a window of opportunity to treat the current situation as a large-scale demonstration of how policy changes could affect the cost and quality of care,” the researchers explained. “CMS also could begin to examine some population health quality measures, such as changes in the rates of hospital readmissions and unexpected emergency room visits.”

Four questions could guide policymakers’ decisions, the researchers recommended. 

Policymakers should question whether CMS or Congress have the authority to end certain waivers. Then, they should ask about the impacts on beneficiary care and out-of-pocket spending. It would also be important to answer what the fiscal benefits and risks would be for Medicare and, lastly, they should consider how they could mitigate those risks.

Medicare Advantage plans certainly stepped up to the plate to utilize flexibilities and waivers during the coronavirus pandemic to protect their vulnerable membership populations with certain metrics actually improving through the pandemic in some cases. For example, Humana saw an overall improvement in mental and physical health in its Medicare Advantage members.

However, data will be crucial to assessing which temporary regulatory changes remain and which will expire, particularly when it comes to determining how to permanently integrate telehealth coverage as Tim Epple, principal at Avalere, has agreed.

“The data is still being developed to understand what the actual cost offsets or what the right payment rate looks like for telehealth. That’s something that we've talked to both plans and providers a lot about,” Epple told HealthPayerIntelligence. 

“If there is any silver lining to 2020 in the last six months, I do think a lot of it is going to be the fact that payers are now generating a lot of data about how their chronic care patients have access to services via telehealth.”

As the country starts to stabilize and payers prepare for the future, industry leaders can anticipate that CMS may leverage these temporary flexibilities to enhance Medicare coverage.