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What They’re Saying about the Medicare Part B Demo

September 22, 2016
Back in March, CMS’s Center for Medicare and Medicaid Innovation (CMMI) proposed a sweeping demonstration project that would dramatically lower the rate at which many providers are reimbursed for medicines administered under Medicare Part B. Medicare Part B  covers drugs administered in a provider setting, and patients served under the program include those fighting diseases such as cancer, multiple sclerosis, macular degeneration, rheumatoid arthritis and primary immunodeficiency diseases – those most in need of the medicines their doctors provide. BIO – and many others – have expressed our concern that CMMI’s proposed demonstration would threaten these patient’s access to these critical medicines by reducing or eliminating the ability of many providers to administer them, particularly those in smaller offices or rural settings.

Writing in Forbes yesterday, the Galen Institute’s Grace-Marie Turner notes that the proposal also raises serious concerns regarding the separation of powers:
The Part B demo represents a dramatic shift in power between the executive and legislative branches of government, and Congress is incensed.  In a letter to CMS currently being circulated for signatures by Chairman Price, Rep. Charles Boustany (R-LA), and Rep. Eric Paulsen (R-MN), they say the proposed CMMI payment rule is an “overstep of authority, given the mandatory participation required of thousands of providers and millions of patients with serious conditions and rare diseases on a near-nationwide scale.”

“CMS’s Part B proposal…would rewrite Medicare Part B payment law for 75% of the country without going through the Constitutional procedures where legislation is debated and approved in both chambers of Congress, and subsequently signed by the President,” the legislators write.

And former CBO director Dan Crippen writes in the Morning Consult:
Untested payment changes for Medicare benefits, especially when mandatory and applied to tens of millions of recipients, should receive much more consideration than a brief public comment period before the initiation of the new policy.

Having worked both in the Congress and the White House, I understand the frustrations and tensions between the congressional and executive branches. And at the end of an administration, which I also experienced, there is always unfinished business. As a member of the team that reviewed end-of-term proposals, I can confidently say this CMMI proposal is not one we would have approved. With limited ability for oversight under this framework, Congress should exercise its authority and halt this experiment until it can properly consider the effects of the proposed policy.

Read Grace Marie-Turner’s full piece here, and Dan Crippen’s piece here.