Authors Posts by Sarah Eyster

Sarah Eyster

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Ms. Eyster represents the association at state-level meetings and serves as staff liaison to the Mental Health Committee. She is responsible for member communication of, and the analysis of, Department of Human Services and other key policy decisions.

Mental Health America (MHA) has just launched our new Young Mental Health Leaders Council (YMHLC), dedicated to finding young adults (18–25) who have created programs and initiatives that fill gaps in mental health support in their communities. YMHLC brings together young leaders from across the United States to share their ideas, connect with other leaders, gain new opportunities, and promote their ideas and work through MHA’s network and annual report. The goal of YMHLC is to amplify and expand the work of young leaders in mental health and to share tools and resources for other young people looking to build or enhance resources and advocate in their communities. Applications for the first cohort close on Friday, August 14. You can find out more at mhanational.org/youngleaders 

The Office of Disability Employment Policy posted information on the Americans with Disabilities Act (ADA) in commemoration of the 30th anniversary of its signing on July 26, 1990. Featured is a timeline highlighting disability employment legislation enacted since the signing of the ADA and other notable related events from the past 30 years. Also included are suggestions on ways for organizations and individuals to celebrate ADA30.

Celebrating ADA30 Webinar

The Employer Assistance and Resource Network on Disability Inclusion (EARN) will host a webinar on “Celebrating ADA30: A Discussion on Youth Employment from the ADA Generation” on July 24 from 1:00 pm – 2:00 pm ET. During this webinar, young people with disabilities who grew up after the passage of the Americans with Disabilities Act (ADA), known as the “ADA Generation,” will discuss their experiences in the workplace and offer ideas to help employers attract young people with disabilities. They will address policies and programs of particular interest to younger workers with disabilities; including internship, apprenticeship, and mentorship opportunities, and how to ensure they are accessible. They will also touch on how young people with disabilities view disability disclosure and self-identification. A representative from the Institute on Disability at the University of New Hampshire will review key findings of the “2020 Kessler Foundation National Employment and Disability Survey: Recent College Graduates.”

New office to continue agency’s work of reducing regulatory burden to allow providers to focus on patients instead of paperwork and reducing health care costs

Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the creation of the Office of Burden Reduction and Health Informatics to unify the agency’s efforts to reduce regulatory and administrative burden and to further the goal of putting patients first. The new office is an outgrowth of the agency’s Patients over Paperwork (PoP) Initiative, which is the cornerstone of CMS’s ongoing efforts to implement President Trump’s 2017 executive order to “Cut the Red Tape” and eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This announcement permanently embeds a culture of burden reduction across all platforms of CMS agency operations.

CMS’s burden reduction work began three years ago with the launch of our PoP Initiative, which has focused on reducing unnecessary regulatory burden, in order to allow providers to concentrate on their primary mission: patient care. The results are expected to save providers and clinicians $6.6 billion and 42 million unnecessary burden hours through 2021. As part of our efforts to date, CMS has heard from over 2,500 providers, clinicians, administrative staff, health care leaders, beneficiaries and their support teams through 158 site visits and listening sessions. Through more than 10 Requests for Information (RFI) combined with stakeholder interviews, CMS also has over 15,000 comments to assist us in our burden reduction efforts.

These efforts have yielded significant results:

  • Removed unnecessary, obsolete, or excessively burdensome conditions of participation for hospitals and other healthcare providers saving an estimated 4.4 million hours of time previously spent on paperwork with an overall total projected savings to providers of $800 million annually.[1]
  • Removed 235 data elements from 33 items on the Outcomes and Assessment Information Set (OASIS) assessment instrument for home health.
  • Established within the Quality Payment Program (QPP), a consolidated data submission experience for the different performance categories of the Merit-based Incentive Payment System (MIPS) so that clinicians no longer need to submit data in multiple systems.
  • Eliminated 79 measures, through modernizing proposals to advance our Meaningful Measures Initiative, resulting in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours through 2020.
  • Implemented changes resulting in faster processing of state requests to make program or benefit changes to their respective Medicaid programs through the state plan amendment (SPA) and section 1915 waiver review process. 

“The Office of Burden Reduction and Health Informatics will ensure the agency’s commitment to reduce administrative costs and enact meaningful and lasting change in our nation’s health care system,” said CMS Administrator Seema Verma. “Specifically, the work of this new office will be targeted to help reduce unnecessary burden, increase efficiencies, continue administrative simplification, increase the use of health informatics, and improve the beneficiary experience.”

Today’s announcement continues CMS’s burden reduction efforts from both before and during the COVID-19 pandemic. When President Trump declared a national coronavirus emergency on March 13, 2020, CMS took action nationwide to aggressively respond to COVID-19. In March, CMS announced unprecedented relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs, including the 1.2 million clinicians in the Quality Payment Program who are on the front lines of America’s fight against COVID-19, by granting them exceptions to reporting requirements and extensions for reporting measures and data.

Under these extreme and uncontrollable circumstances, CMS also implemented additional exceptions for upcoming measure reporting and data submission deadlines for a number of programs, including provider, hospital, and post-acute programs, during the COVID-19 emergency. Additionally, during the pandemic CMS has taken actions to ease federal rules and to institute new flexibilities to ensure that states and localities can focus on patient care and can ensure that care is not delayed due to administrative red tape. CMS is committed to leveraging the significant flexibilities introduced in response to the COVID-19 pandemic as we continue to lead the rapid transformation to value-based healthcare.

The new office will strengthen CMS’s efforts across Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace to decrease the hours and costs clinicians and providers incur for CMS-mandated compliance. It will take a proactive approach to reducing burden, carefully considering the impact of new regulations on health care system operations. The new office will also increase the number of clinicians, providers, and health plans the Agency engages, to ensure that CMS has a better understanding of how various regulatory burdens impact healthcare delivery. Stakeholder feedback is critical to addressing provider and clinician burden, as it helps CMS to remove or modify outdated regulations that impede innovation, ultimately resulting in improvements in healthcare delivery.

Additionally, the Office of Burden Reduction and Health Informatics will focus on the important work of health informatics, which uses and applies health data and clinical information to provide better healthcare to patients. Fostering innovation through interoperability will be an important priority, and the office will leverage technology and automation to create new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the health care system. By providing clinicians with a complete medical history, they can deliver better coordinated, higher quality care. Coupled with implementation and enforcement of adopted national standards, this office will also work with the broader healthcare community to continue to make key administrative processes increasingly more efficient.

With the formation of the Office of Burden Reduction and Health Informatics, CMS will continue to draw on the specialized expertise of staff, and frequent stakeholder input, to continue to explore innovative ways to address regulatory reform and burden reduction. All of these efforts will help ensure that providers and clinicians can focus their efforts on what is most important: keeping patients healthy, improving health outcomes, and enhancing patient satisfaction.

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS and @CMSgov

Proposed rule updates provisions to promote value-based payment for prescription drugs

As part of President Trump’s longstanding commitment to lowering drug prices, today the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would start to remove barriers to the development of payment models based on value for innovative new therapies.  Therapies are coming to market today that fight disease in an entirely new way, including at the genetic level.  While the impact of these therapies can be transformative, their costs are unprecedented.  New approaches to payment are needed to allow the market room to adapt to these types of curative treatments while ensuring that public programs like Medicaid remain sustainable.  Several proposals will also enhance CMS’s efforts to combat the opioid epidemic and make sure that opioid outpatient drug coverage is appropriate, medically necessary, and avoids adverse medical events.

“CMS’s rules for ensuring that Medicaid receives the lowest price available for prescription drugs have not been updated in thirty years and are blocking the opportunity for markets to create innovative payment models,” said CMS Administrator Seema Verma.  “By modernizing our rules, we are creating opportunities for drug manufacturers to have skin in the game through payment arrangement that challenge them to put their money where their mouth is.”

Under current regulations, prescription drug manufacturers face challenges reporting payments under value-based arrangements to CMS.  Current regulations hinder payers and manufacturers from designing new payment arrangements based on the value provided to a patient, which leads to price negotiations based on quantity of drugs sold instead of the quality of a drug product, as well as efforts by payers to limit access to emerging treatments through utilization management practices like prior authorization and step therapy.  Today’s proposals seek to modernize these regulations, encouraging innovation and empowering states, private payers, and manufacturers to pay for prescription drugs based on clinical outcomes.  Basing payment on the effectiveness of a given therapy can foster innovation in the treatments that are most impactful to patients, while reducing overall healthcare spending and hospital visits.

These proposals would support the healthcare system’s move to paying on the basis of value instead of volume and increasing accountability for outcomes, as insurers would be able to better negotiate discounts based on a drug’s effectiveness.  In addition, more widespread adoption of payment arrangements based on value could lead to the collection of more evidence on clinical outcomes for a given therapy.  This type of real-world, real-time evidence could help providers use new medications and treatments in a more targeted fashion.  Increasing the link between reimbursement and drug effectiveness will also encourage payers to facilitate patients’ access to new therapies by easing more traditional utilization management practices.

By offering more flexibility for payers and manufacturers to enter into value-based agreements while still ensuring that Medicaid always gets the best deal, CMS is continuing our efforts to foster innovation, increase access to the latest technologies, and ensure that the Medicaid program is sustainable and can continue to serve our most vulnerable populations.

These proposals build on the steps that the Trump Administration has already taken to lower drug prices including the following actions:

  • In Medicare Part D, which covers prescription drugs that beneficiaries pick up at the pharmacy, the average basic premium for Medicare Part D prescription drug plans was projected to decline 13.5 percent since 2017 to the lowest level in seven years, saving beneficiaries about $1.9 billion in premium costs over that time.
  • Announced the Senior Savings Model where, starting in 2021, participating enhanced Part D prescription drug plans across the country will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, saving beneficiaries on average $446 for their insulins.
  • Allowing Part D plans to substitute certain generic drugs to onto plan formularies more quickly during the year, so beneficiaries immediately have lower cost sharing for these drugs.
  • Increasing competition among plans by removing the requirement that certain Part D plans have to “meaningfully differ” from each other, making more plan options available for beneficiaries.
  • Providing more information on out-of-pocket costs for prescription drugs to beneficiaries by requiring Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket drug costs at the time a prescription is written.
  • Implementing Part D legislation signed by President Trump to prohibit “gag clauses,” which keep pharmacists from telling patients about lower-cost ways to obtain prescription drugs.
  • Approved state plan amendments from eight states to negotiate supplemental rebate agreements involving innovative value-based payment arrangements with drug manufacturers, so states can demand results from manufacturers in exchange for payment.
  • Issued guidance intended to help states monitor and audit Medicaid and CHIP managed care plans to identify spread pricing when calculating their medical loss ratio (MLR).

The changes CMS is proposing also furthers the Trump Administration’s efforts to combat the opioid crisis.  The proposed rule would implement provisions under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act to promote safe prescribing of opioids and other medications, which is essential to prevent and reduce opioid misuse and abuse.  These proposals include standards that would enhance a states’ ability to identify or limit inappropriate prescribing of opioids if a beneficiary is already receiving medication assisted treatment for substance use disorder (SUD).

CMS is also seeking input on proposals for future rulemaking that would require additional review of opioid prescribing, medication assisted treatment, and naloxone prescribing.  CMS is requesting comments on potential new standards that would enhance states’ ability to identify or limit inappropriate prescribing of opioids if a beneficiary is already receiving medications that can be unsafe when taken with opioids.  These proposals are key to addressing the misuse and overuse of opioids in order to help reduce hospitalizations, emergency department visits, and family crises associated with the epidemic.

A Fact Sheet on the Proposed Rule can be viewed at: https://www.cms.gov/newsroom/fact-sheets/establishing-minimum-standards-medicaid-state-drug-utilization-review-dur-and-supporting-value-based

The Proposed Rule can be viewed at: https://www.federalregister.gov/documents/2020/06/19/2020-12970/medicare-program-establishing-minimum-standards-in-medicaid-state-drug-utilization-review-and

CMS released additional Frequently Asked Questions (FAQs) on their recent COVID-19-related waivers to help providers, including physicians, hospitals, and rural health clinics. Find more answers to questions on:

  • Outpatient therapy;
  • Telehealth and appropriate coding; and
  • Federally qualified health centers.

Bookmark this document and check back for additional updates.

For More Information:

Final Rule continues to strengthen the popular private Medicare health and drug plans

The Centers for Medicare & Medicaid Services today finalized requirements that will increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases, provide support for more MA options for beneficiaries in rural communities, and expand access to MA for patients with End Stage Renal Disease (ESRD). Together, the changes advance President Trump’s Executive Orders on Protecting and Improving Medicare for Our Nation’s Seniors and Advancing American Kidney Health as well as several of the CMS strategic initiatives.

Due to the upcoming June 1, 2020, MA and Part D bid deadlines for the 2021 plan year, CMS is finalizing a subset of the proposed policies before the MA and Part D plans’ bids are due. CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year. We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to coronavirus disease 2019 (COVID-19), and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries.

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

Building on actions that the Trump Administration has taken to expand access to telehealth so beneficiaries can get care at home instead of traveling to a healthcare facility, today’s rule encourages MA plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas. CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas (such as Dermatology, Psychiatry, Cardiology, Ophthalmology, Nephrology, Primary Care, Gynecology, Endocrinology, and Infectious Diseases) towards meeting CMS network adequacy standards. This flexibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas.

Today’s rule gives beneficiaries with ESRD more coverage choices in the Medicare program. Previously, beneficiaries with ESRD were only allowed to enroll in MA plans in limited circumstances. The rule implements the changes made by the 21st Century Cures Act to give all beneficiaries with ESRD the option to enroll in an MA plan starting in 2021. This will give beneficiaries with ESRD access to more affordable Medicare coverage options that may include extra benefits such as health and wellness programs, transportation, or home-delivered meals that are not available in Medicare Fee-For-Service.

CMS is also finalizing proposals to enhance the MA and Part D Star Ratings system to further increase the impact that patient experience and access measures have on a plan’s overall Star Rating. The Star Ratings system helps people with Medicare, their families, and their caregivers compare the quality of health and drug plans being offered. One of the best indicators of a plan’s quality is how its enrollees feel about their coverage experience. This decision reflects CMS’s commitment to put patients first and improves incentives for plans to focus on what patients value and feel is important. Additionally, CMS adopted a series of changes in the March 31, 2020, Interim Final Rule with Comment Period (CMS-1744-IFC) for the 2021 and 2022 Star Ratings to accommodate challenges arising from the COVID-19 public health emergency.

For a fact sheet on the Contract Year 2021 Medicare Advantage and Part D Final Rule (CMS-4190-F1), please visit: https://www.cms.gov/newsroom/fact-sheets/contract-year-2021-medicare-advantage-and-part-d-final-rule-cms-4190-f1-fact-sheet

The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program

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Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS and @CMSgov.

Please see the memorandum for guidance on the suspension of certain prior authorization requirements for behavioral health providers enrolled in the PA Medical Assistance program. The Office of Mental Health and Substance Abuse Services (OMHSAS) anticipates these suspensions to facilitate access to services during the COVID-19 disaster emergency declaration period. RCPA staff will be reaching out to the behavioral health managed care organizations to learn how they are implementing this guidance from OMSHAS. If you have questions or concerns regarding this memo, please e-mail ra-pwomhsascovid-19@pa.gov.