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1 Gail R. Wilensky Project HOPE July 9, 2010 Implementing PPACA.

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Presentation on theme: "1 Gail R. Wilensky Project HOPE July 9, 2010 Implementing PPACA."— Presentation transcript:

1 1 Gail R. Wilensky Project HOPE July 9, 2010 Implementing PPACA

2 2 Many Challenges Huge, complex bill Many changes affecting -- State governments -- HHS -- CMS

3 3 CMS – The Agency Congress Loves to Hate Agency has been starved for funds -- Equal opportunity abuse by Rs and Ds and by Executive Branch and Congress Many retirements in last decade -- ing institutional knowledge Additional funding for implementation -- Only temporary A challenged organization …

4 4 Additional Challenges for CMS Recent reorganization/realignment (March 24) -- Reorganizations always cause turmoil/disruption No confirmed administrator since 2006 Recess appointment of Don Berwick -- Limits his tenure to 18 months -- Further damages his relationship with Rs

5 5 So … Now What? CMS (and other parts of HHS) are: -- Forming workgroups -- Drafting time-lines for reg production -- Establishing review processes, strategies to resolve disputes -- Meeting on a frequent/regular basis Making sure adequate resources are focused on routine functions -- i.e., running Medicare, overseeing Medicaid

6 6 Early 1990s Experience: RBRVS Challenges: RBRVS incomplete when passed Outreach needs to physician population Write and post proposed rule -- Internal inconsistencies in the law -- 100,000 responses Outcome: Final rule/operational changes on time Passed 11/89, Implementation 1/1/92

7 7 Much More Challenging Time -- Even More than BBA Put in place all of the changes for the annual updates Start many one-time changes Create a new Innovation Center Provide oversight for annual Medicaid changes -- home health option, drug rebate changes, various state options

8 8 One of Many Thorny Challenges for CMS Establishing rules/regulation for Hospital Value-Based Purchasing Program -- Regs regarding performance measures, methodology to calculate hospital performance score, methodology to determine amt of incentive-based payments, etc. -- All likely to be very controversial, expect a lot of responses -- Be ready to go by 2012


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