Thursday, January 19, 2017

Brief Blog: Conway = CMS Acting Administrator; New Medicare Law re Appeals, Precedents

Three items of CMS news:
  • Slavitt Steps Down
  • Conway, Bassano Step Up
  • Making Appeals Decisions Precedent-Setting
Slavitt Steps Down
Acting Administrator Andy Slavitt stepped down from his leadership roll at CMS, and leaves behind a blog describing his experiences, here.  Slavitt, a Harvard MBA, and previously worked at McKinsey and as an EVP at Optum.   He gave a 3300-word fireside chat at January's JP Morgan conference in San Francisco (here), which streamed publicly on the JPM website.

Conway, Bassano Step Up
Patrick Conway, currently head of CMMI and also Chief Medical Officer, will act as Acting Administrator until the Senate confirms a Trump Administration appointee (or until a different Acting Administrator is named.)   Amy Bassano will be Acting Director of CMMI.  Some on the Hill have proposed discontinuing CMMI has part of Obamacare repeal (eg here.)

Making Appeals Decisions Precedent-Setting
In other news, CMS has published regulations allowing it to make certain decisions of the Medicare Appeals Council "precedential," meaning they can be more rapidly and easily enforced when similar cases arise in the appeals process.   Lawmaking at 82 FR 4974 (January 17, 2017) is here.  (The 167-page rule has other parts, such as revising the Part D appeals process.)
  • The regulations attempt to deal with the colossal delays and backlogs in the appeals process.   See e.g. here.  
  • A December blog at this website, here.
  • Trade journal article here . 
  • Precedential rulings means that a favorable one should be repeated consistently in future hearings on the same topic.  But if an unfavorable one becomes precedential, it may be more difficult to return to the judges with new arguments leading to a favorable decision in future similar cases.