CMS leaders share insights on deregulation, Medicare Advantage oversight

Leaders from the Centers for Medicare & Medicaid Services discussed issues on the agency’s agenda in a fireside chat moderated by Ashley Thompson, AHA senior vice president, public policy analysis and development. Stephanie Carlton, CMS deputy administrator and chief of staff, and John Brooks, CMS deputy administrator and chief policy and regulatory officer, discussed regulatory burden and oversight of commercial health insurance plans, among other topics.

Brooks discussed the challenges imposed on hospitals and health systems when faced with new regulatory requirements annually.

“It’s really critical to stop, take stock and assess the cumulative weight on all those regulations on industry,” he said. “We need to look across the board, whether it’s claims administration, requirements around Conditions of Participation or quality of measurement.”

The officials also discussed Medicare Advantage and oversight of commercial health plans, stressing the need for prior authorization policies to work efficiently and not become used as a tool to deny care and place a burden on providers.

“It’s not supposed to be the tool itself to prevent care from being given, and I think we’ve seen that happen in a lot of cases,” Brooks said. “So I think that’s an area where we definitely plan to spend some time over the next year or two to try and figure out.”
 
Carlton discussed value-based care and its potential for growth, particularly in rural areas.

“Rural access is really important to us, and I think there’s an important way to think creatively about models that will work in rural areas,” she said. “Obviously, access in different places is critical, but [we need to] think about how do we do that and how do we work with smaller sites.”