Telehealth, Regulation & Rural Care — What CMS Nominee Chiquita Brooks-LaSure’s Confirmation Hearing Tells Us About the Future of Medicare & Medicaid

Man talking into microphone at confirmation hearing to discuss the future of Medicare, Medicaid, and Telehealth

Chiquita Brooks-LaSure, President Joe Biden’s nominee to head the agency that oversees Medicare and Medicaid, has decades of experience in health policy and is seen as a solid pick to head the agency. Her confirmation hearing, which took place April 15, included extensive questioning that revealed priority issues both for the Senate and for Brooks-LaSure.

The Senate is expected to vote on her confirmation in the coming weeks. In the meantime, here are a few takeaways gleaned from the nominee who may soon serve as Administrator for the Centers for Medicare & Medicaid Services (CMS):

1. Access to Rural Health Care Is a Priority

Senator Mark Warner secured a commitment from Brooks-LaSure to support a proposed bill to bolster payments to rural hospitals by establishing a national minimum wage index. Medicare uses a “Medicare area wage index” to reimburse hospitals. The index is currently much lower for providers in rural and other low-wage communities since the index is based on labors costs, which vary across the country. The proposed legislation is aimed at fixing the flawed formula and keep more rural hospitals and health care providers afloat. More than 130 rural hospitals around the nation have closed since 2010.

In addition, Brooks-LaSure highlighted the recent success of telehealth in serving rural communities:

“This pandemic has given us an opportunity to take the lessons across a variety of issues, and telehealth is something that’s been discussed for more than a decade, and now we’ve been able to see what value it brings,” Brooks-LaSure said.

2. Telehealth Flexibility Could Become Permanent

Telehealth was a hot topic at the confirmation hearing, with many Senators pushing Brooks-LaSure for a commitment to working with Congress to extend temporary COVID-19 measures and ensure the continuation of the telehealth boom.

Senators highlighted the tremendous growth of telehealth through flexibilities adopted during COVID-19. This includes emergency rules that allow Medicare to reimburse telehealth services at the same rate as in-person visits.

Brooks-LaSure stated that she intends to examine CMS’ authority when it comes to extending waivers set to expire at the end of the public health emergency (recently extended by HHS Secretary Xavier Becerra for 90 days effective April 21) and explore ways to bring “lessons that we’ve learned from COVID into our healthcare system on a permanent basis.” She stopped short of stating what the reimbursement rate for telehealth should be in a post-pandemic world.

3. CMS Will Study Telehealth Expansion for Abuse Safeguards

While Brooks-LaSure did not shed much light on what the reimbursement rate for telehealth should be when asked by Senators, the nominee did note that further investigation and study would be needed to identify “safeguards” to ensure program integrity and that services are being delivered.

This suggests not only that more permanent telehealth flexibilities are on the horizon, but also that the agency will be working diligently to identify and implement significant protections to prevent and root out waste, fraud, and abuse.

Counsel for Health Care Clients in the Post-Pandemic World

Brooks-LaSure’s expected (though not entirely conflict-free) confirmation as CMS Director will be one of many new changes likely to transform the health care space in coming years.

For providers, hospitals, home care providers, and health care companies, staying ahead of the curve and establishing the foundation for future growth and success will depend less on the individual named to lead CMS and more on the ability to prepare for and adapt to ever-evolving changes in the regulatory and enforcement environment.

At Hendershot Cowart P.C., our health and medical law team regularly counsels providers, physicians, and entrepreneurs of all types looking to seize opportunities in post-pandemic world, including those related to telemedicine. To discuss your needs with a member of our team, call or contact us online.

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