This week our In Focus section reviews the issue brief and policymaker playbook that explore the outlook for temporary COVID-19-related changes to the Medicare and Medicaid programs, prepared in partnership with Manatt Health for The SCAN Foundation. HMA experts Jennifer Podulka, Yamini Narayan, and Keyan Javadi offer a framework to support policymakers’ decisions on the future of temporary policies and highlight specific flexibilities that are good candidates for consideration. These temporary flexibilities expanded program eligibility and enrollment, enhanced remote service delivery options, authorized care delivery in alternative care sites, and much more.
As the COVID-19 emergency recedes and policymakers prepare for the unwinding of these temporary policies, they have the unique opportunity to assess their impact on advancing person- and community-centered care and consider flexibilities for permanence through this lens. In this context, person-centered care means health care that is guided by an individual’s personal values and preferences and is designed to help people achieve what matters most to them. By extension, community-centered care is health care that is guided by a community’s values and preferences. Yet, policymakers and other stakeholders have only started to understand the impact of these flexibilities on health care consumers and the providers and systems that provide their care.
Uneven data collection and reporting do not yet support a comprehensive analysis of the impact of the flexibilities on consumer access, service utilization, and outcomes, as well as on the provider and direct care workforce. The limited quantitative data that do exist indicate that telehealth flexibilities facilitate access to timely care in individuals’ homes or communities. Qualitative data are more abundant and support the use of telehealth and provider workforce flexibilities to improve access to care but suggest that certain flexibilities may widen health disparities or harm patient care if not implemented with modifications designed to ameliorate these risks.
At the outset of the pandemic, regulatory flexibilities were implemented quickly to minimize disruptions in access to care. In many cases, the regulatory changes aligned Medicare and Medicaid program policies that were previously misaligned; for example, Medicare temporarily allows patients to use telehealth in their homes, similar to pre-COVID-19 policies in many states. Without further federal or state action to adopt temporary flexibilities as permanent policy, a return to pre-pandemic rules will result in a return to the complex regulatory web that consumers and providers had to navigate prior to 2020.
As policymakers consider which temporary regulatory flexibilities might improve the Medicare and Medicaid programs if continued as permanent policies, they will be faced with complex decisions weighing the impact on consumers and providers, the opportunities for programmatic alignment, the ability of modifications to address risks, and the possibility of additional evaluation before making a final choice.
HMA and Manatt Health have developed a person-centered assessment framework to facilitate these decisions. The framework assesses the potential for the regulatory flexibilities to:
- advance person- and community-centered care,
- facilitate care in the least intensive or least restrictive setting, and
- better align Medicare and Medicaid program rules.
The person-centered assessment framework was tested and refined with a diverse group of stakeholders, including consumers and consumer advocates, experts in diversity, equity, and inclusion (DEI), health plans and providers, state officials, and former federal officials, to ensure it would be an actionable tool for federal and state policymakers. The person-centered assessment framework is organized into the following three sections, each with probing questions for policymakers to consider as they deploy the tool: benefits and risks, informed decision making, and regulatory authority.
Using the person-centered assessment framework, and informed by stakeholders, the authors identified several priority COVID-19 temporary regulatory flexibilities to consider for permanence, additional modification, or further evaluation. These flexibilities fall under four major categories and were selected based on their ability to promote person- and community-centered care in the least intensive or least restrictive setting and better align Medicare and Medicaid program rules and policies:
- Expand telehealth benefits
- Modify provider scope of practice and related requirements
- Modify Medicare Advantage (MA) requirements
- Continue other temporary flexibilities
The person-centered assessment framework and priority list of flexibilities for permanence or further evaluation are foundational tools for policymakers hoping to advance person-centered care in Medicare and Medicaid. The issue brief provides a rationale for elevating specific flexibilities among the hundreds that were implemented during the pandemic, discusses the benefits and risks for consumers, communities, and other stakeholders, and identifies at a high-level the authorities that would be needed to continue the policies after the COVID-19 emergency ends.
The Alliance for Health Policy, in partnership with HMA and Manatt Health, is hosting a public webinar to discuss the future of COVID-19-era Medicare and Medicaid Flexibilities. This event will provide an overview of the flexibilities that were implemented and expanded during the nation’s Public Health Emergency and will evaluate insights from recent research and on-the-ground experts. Panelists will also discuss policy levers available to state and federal policymakers to build upon these current flexibilities. The webinar will be Wednesday, March 30, 2022, from 12:00 – 1:30 p.m. ET. The registration link is https://attendee.gotowebinar.com/register/7643779968838958863?source=SCAN
HMA staff have extensive experience assessing the implications of the COVID-19-related flexibilities. If your organization is interested in assessing how the outcome of these flexibilities as the public health emergency ends impacts you, contact Jennifer Podulka, to learn how our expert team can assist with a data-based consultation.