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Which Medicare Changes Should Continue Beyond the COVID-19 Pandemic? Four Questions for Policymakers

In an issue brief prepared for The Commonwealth Fund and The SCAN Foundation, HMA consultant Jennifer Podulka and Vice President Jonathan Blum, analyze the temporary COVID-19-related changes to Medicare regulations, described the benefits and risks of the changes, and offered a framework to support policymakers’ decisions on the future of these temporary policies.

Congress and the administration responded to the COVID-19 pandemic with a series of policy changes designed to provide temporary relief from certain Medicare rules. Most of these pandemic-related regulatory changes will expire at the end of the public health emergency, which began in January 2020 and is expected to run through the end of 2021.  Policymakers can either allow these actions to expire as scheduled or consider potential modifications to these policies, including whether to make them permanent.

To date, Congress and the administration have taken action to expand or make permanent twenty-seven, or 11 percent, of the temporary policies. Most of these policies focus on payment systems and quality programs, provider capacity and workforce, and telehealth.  For example, nine telehealth services that were permitted on a temporary basis were moved to the permanent, Medicare-approved list; additional telehealth services will continue on a temporary basis through the end of the year that the COVID-19 emergency officially ends; and the scope of practice for non-physician practitioners was modestly expanded to the extent permissible under various state laws and regulations so that these practitioners can now provide and bill Medicare for services that had been reserved to physicians or certain other practitioners.

With more than 200 COVID-19-related temporary regulatory changes still in effect, it is likely that the administration and Congress will continue efforts to modify and extend at least some of these changes. Currently, policymakers and healthcare stakeholders have little information about the effects of COVID-19-related regulatory changes. Yet some of these changes are likely having a significant impact on how care is provided to Medicare beneficiaries. Given that these changes have now been in effect for more than a year, the Centers for Medicare & Medicaid Services (CMS) could explore their impacts and provide findings to policymakers and other stakeholders in a transparent manner. In fact, 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 breadth and scale of these changes — which may generally affect more providers and beneficiaries due to their national scale than Innovation Center and Medicare Advantage efforts — could provide unique insights into how Medicare’s regulatory structures could be modified to improve beneficiary care.

In anticipation of the availability of evaluation findings, we offer a framework for policymakers to use in considering whether to modify, extend, or make permanent pandemic-related regulatory changes to Medicare. The framework consists of four key questions:

  • Do CMS or Congress have the authority to make a change permanent after the public health emergency ends?
  • What are key potential benefits and risks to beneficiary care and out-of-pocket spending?
  • What are key potential benefits and risks to inappropriate Medicare program spending?
  • What are key policies that CMS or Congress could implement to mitigate the potential risks?

The full issue brief walks through potential answers to each of these questions.

In conclusion, Congress and the administration made more than 200 temporary changes to the Medicare program in response to the COVID-19 pandemic. Most of these changes are likely to remain part of the Medicare program through the end of 2021. Some of the changes may prove to be beneficial as permanent Medicare policies. If CMS were to capitalize on the unique opportunity of the temporary changes by undertaking rapid, large-scale evaluations of the effects of the changes, the results could inform policymakers’ decisions about future actions. Such a substantial research effort would provide CMS and the new Congress with data-supported insights into the relative benefits and risks of each COVID-19-related action as they consider which policies should continue into the future.

The full issue brief can be found here.

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