Consumer / Employer, Payers

CMS Administrator: Telehealth Flexibilities Greatly Expanded Access, But Up To Congress To Extend

During an interview at the AHIP Medicare, Medicaid, Duals and Commercial Markets Forum held Tuesday in Washington, D.C., CMS Administrator Chiquita Brooks-LaSure discussed CMS’ key focus areas for 2023. This includes the end of the public health emergency, health equity and prescription drug costs.

The telehealth flexibilities allowed during the Covid-19 public health emergency greatly expanded access to healthcare services. But after the public health emergency ends, it’s ultimately up to Congress to further extend these flexibilities, said CMS Administrator Chiquita Brooks-LaSure.

Brooks-LaSure made these comments in an interview after her speech at the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum held Tuesday in Washington, D.C. She outlined the following areas as key priorities for CMS in 2023.

Unwinding of the Covid-19 public health emergency

After more than three years, the Covid-19 public health emergency is set to expire May 11. When this ends, so will several flexibilities allowed during the pandemic, including the coverage of Covid-19 testing. Some telehealth flexibilities were extended to 2024, such as coverage for telehealth services via Medicare, while others are set to expire May 11. 

While telehealth greatly expanded access to care, it’s Congress’ responsibility to further extend any flexibilities, Brooks-LaSure told MedCity.

“Telehealth has been incredible for many of the underserved populations, and honestly for non-underserved populations as well. … We want to make sure that people are able to get the care that they need and so there are certain settings where telehealth is appropriate,” Brooks-LaSure stated. “We also want to make sure that people can get in to see a doctor if they need to. That’s really been our focus of extending where we can. … But we need more authority from Congress to make any of the other flexibilities last longer than they’re currently lasting.”

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

The public health emergency also allowed the continuous enrollment provision, which barred states from disenrolling Medicaid enrollees. The Consolidated Appropriations Act signed into law in December separated the provision from the public health emergency and gave the end date of March 31, requiring states to resume redeterminations. As many as 18 million people could lose coverage once this ends.

“This is one of our number one areas of focus,” Brooks-LaSure said. “One of the things we’re doing is really working with the states very closely to try to help them meet the standards that Congress laid out in terms of the data they need to provide to us. The goal, really, is to make sure that everybody is touched, so that they know, ‘Come in, get redetermined for Medicaid. Or if you’re not eligible for Medicaid, we’re going to transition you to something else.’”

Health equity

Another priority is advancing health equity, particularly in Medicaid and Children’s Health Insurance Plans, Brooks-LaSure said. CMS will be releasing a proposed rule for Medicaid access this spring, she added.

“Alongside the marketplaces, Medicaid and CHIP are at a critical level in our work to strengthen health equity and access in the United States. … More than 70% of people with Medicaid now get coverage through a managed care plan,” Brooks-LaSure said in her speech at the conference. “We’re tackling the barriers they may face in enrolling, maintaining coverage and accessing the care they need.”

CMS is also battling health equity in Medicare Advantage plans, and proposed a health equity index for Medicare Advantage star ratings. This would create a quality measure that examines how plans screen for social factors, including food insecurity, housing insecurity and transportation.

Prescription drug prices

The high cost of prescription drugs is a top concern for many Americans, especially for those battling chronic diseases, Brooks-LaSure stated. The Biden-Harris Administration is working to reduce these costs through the Inflation Reduction Act, which includes a $35 per month cap on insulin. 

In addition, CMS released a timeline in January for implementing the Medicare Drug Price Negotiation Program, which will allow Medicare to directly negotiate drug prices for certain drugs. The program will start with 10 drugs in 2026.

“We are really very close to giving more details about how we’re approaching negotiation,” Brooks-LaSure told MedCity. “We really want a lot of input. … We want to make sure that this works for people. I think we have to do this in partnership to make sure that we get the information we need from drug companies to have a good negotiation, then ultimately, making sure that gets translated into the core benefit delivered by health plans.”

She added that CMS is working to make consumers aware of the new drug benefits.

“Not enough people know about the benefits, and it’s really important that they really understand the drug benefits are changing and what a big deal this is,” she said.

Photo: Marissa Plescia