OMB calls for $800M rescission to Center for Medicare and Medicaid Innovation

The Office of Management and Budget has proposed that Congress rescind $800 million from the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act to test innovative payment and service delivery models leveraging health IT.

“These funds are in excess of amounts needed to carry out the Innovation Center’s planned activities in FYs 2018 and 2019, and the Innovation Center will receive a new mandatory appropriation in FY 2020,” states OMB’s May 8 letter to Congress.

Overall, CMMI has been appropriated $10 billion for its activities in fiscal years 2011 through 2019 and $10 billion per decade beginning in fiscal year 2020.

“Enacting the rescission would allow the Innovation Center to continue its current activity, initiate new activity, and continue to pay for its administrative costs,” added OMB.

However, for the proposed rescissions to take effect, Congress would have to pass legislation implementing them within 45 days.

The OMB proposal comes at a time when CMMI has increasingly come under attack from Republicans, who have called for curbing the organization’s power to mandate programs as well as cutting its funding.

Also See: Boehler takes helm at Center for Medicare and Medicaid Innovation

In September 2017, the Centers for Medicare and Medicaid Services released a request for information from healthcare stakeholders to collect ideas on a “new direction” for CMMI to promote patient-centered care and to test market-driven reforms.

In response to the RFI, the American Medical Informatics Association urged CMS to not only focus on payment reforms, but also put a greater emphasis on the interdependency of payment and delivery reforms supported by informatics. Likewise, HIMSS in its response to the RFI made the case that “health information and technology are essential, foundational elements of meaningful transformation of our nation’s health system.”

CMS says that over the coming year it will use the feedback the agency received as it works to develop new models, focusing on the eight focus areas outlined in the RFI.

Specifically, CMMI is interested in testing models in the following areas: increased participation in Advanced Alternative Payment Models; Consumer-Directed Care and Market-Based Innovation Models; Physician Specialty Models; Prescription Drug Models; Medicare Advantage Innovation Models; State-Based and Local Innovation, including Medicaid-focused Models; Mental and Behavioral Health Models; and Program Integrity.

“We are analyzing all Innovation Center models to determine what is working and should continue, and what isn’t and shouldn’t,” wrote CMS Administrator Seema Verma in a September 2017 op-ed in the Wall Street Journal.

According to the Government Accountability Office, as of March 2018, CMMI had implemented 37 models. Of those 37 models, the testing period has concluded for 10 of them. In addition, GAO reported that the Innovation Center has announced two models to begin testing in 2018.