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 CMS Head Verma Points to SNFs as Priority, but Talks Most on Medicaid, Drugs

In a session with reporters on May 22, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma led off her 34-minute talk by saying skilled nursing care is a top initiative of the agency in 2019. But, during the discussion she did not directly address skilled nursing facilities (SNFs) as the media gathered delved into questions on Medicaid, the cost of pharmaceuticals, and her opposition to Medicare-for-All.

The first priority Verma mentioned, however, among other initiatives that CMS is focusing on this year was nursing care. She reiterated that her office would continue its five-part strategy in this area: quality of care, safety for residents, enforcement, transparency, and reducing burdens on providers.

“We will be spending a lot of time on nursing homes,” Verma said, without offering details beyond the previously stated goals for the oversight CMS performs.

One area that gained a lot of attention during her talk was drug prices and what CMS is doing to in the area of “curative” drugs nearing the marketplace. Some of these drugs have price tags well into the millions of dollars range for gene therapies that cure diseases, a cost that the Medicare and Medicaid systems were not built to incur, she said.

“There are very expensive treatments that are coming along,” Verma said. To come up with ideas on how to pay for the costs, she said the agency is looking for innovators outside the government as well as inside to figure it out. Some ideas being floated are to allow, for instance, a state Medicaid agency to pay for the drugs over time or have the drugs paid at one rate if they cure an individual versus if they do not, the so-called value-based option.

Verma said all of the proposals have good points and bad points, like the value-based option may cause drug makers to hike the launch price of a drug to protect against bad outcomes in which they have to pay rebates to the government.

“I have not found a silver bullet, but I am looking for it,” she said.

On another issues, Verma did not offer details on how or if the agency is working with states on Section 1115 waivers that would allow states to block-grant Medicaid funding. She said the administration remains in favor of giving states as much flexibility as makes sense, and in doing so improve outcomes for Medicaid recipients.

Verma noted that before working in government she consulted on Medicaid issues, giving her a unique perspective on the once-prevailing mindset at CMS, which she called a “mother may I” system. But, she said it is the states that are best suited to make decisions on Medicaid spending, especially as the costs “are number one or two for most states and are crowding out other priorities” like education, workforce, and infrastructure concerns.

On other topics, Verma called the rampant discussion about Medicare-for-All a concern given the fact the proposals from Democrats, many of whom are running for president, do not mesh well with the day-to-day realities of the Medicare program. She said as head of the Medicare program she sees how difficult it is to manage the bureaucracy that comes with the system.

“I think it is important for the American people to understand the implications of a government run [Medicare-for-All] program,” she said. The idea of expanding the present Medicare system and the 65-and-older beneficiaries it serves now to a wider population was hard to understand given the challenges there are in managing the program now, especially when new payment models or other innovations are put into the mix, Verma said.

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