May 26, 2020
Seema Verma, Administrator
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244
Dear Administrator Verma;
Thank you for the opportunity to comment on the Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency interim final rule. The National Committee for Quality Assurance (NCQA) understands that the national priority now must be to let the health care system focus on the COVID-19 crisis and applauds your work to support this.
We strongly support your regulatory changes to allow expansion of telehealth and believe many of these changes should remain after this crisis ends.
We also understand your decision to suspend Medicare Advantage quality reporting for measurement year 2019 and aligned our policies with yours 1. We further greatly appreciate your intention to resume quality reporting for measurement year 2020. It is critical that we maintain the quality reporting and feedback infrastructure and assess the pandemics impact on quality for potential valuable lessons in responding to similar crises in the future.
We provide detailed comments on these and other issues below.
Telehealth: We especially support the many changes to telehealth policies you have made in response to the crisis. These policies increased access, improved safety for both patients and providers, and rapidly advanced the acceleration of telehealth use that was already underway. Even before the pandemic, we updated many HEDIS® measures 2 to incorporate the use of telehealth. We are now working diligently to determine whether we should make additional accommodations for telehealth given the current situation.
We are concerned, however, that the telehealth regulatory changes expire when the Public Health Emergency declaration ends. We share a broad and growing consensus that many of these policies should remain after the pandemic.
Patients are rapidly becoming accustom to the improved access and safety telehealth offers, including seniors who some thought were averse to such technology. Clinicians are demonstrating that they can use telehealth effectively and efficiently. Many state and private payers have rapidly expanded telehealth, as well. And we agree with your statement reported in the Wall Street Journal that “there’s absolutely no going back.” 3
To address this “new normal,” NCQA, the American Telehealth Association, the Alliance for Connected Care and others are developing a Telehealth Task Force. Our goal is to convene experts and leaders to develop policy recommendations for long-term integration of telehealth into our healthcare system – including on quality measurement, reimbursement and data exchange.
We hope that CMS will join with us in this endeavor. We look forward to working with you and other stakeholders to appropriately maintain this telehealth expansion by conducting a thorough examination of what we are learning now and what policies might be needed to protect patients and program integrity going forward.
Medicare Advantage Quality Reporting: We understand the decision to eliminate Medicare Advantage measurement year 2019 quality reporting requirements was to allow plans to focus on addressing the crisis. We greatly appreciate that you allowed plans to report for their own internal quality improvement purposes, which provided necessary flexibility for them to focus on the crisis while allowing the quality reporting and feedback infrastructure to continue where feasible. We kept our HEDIS reporting systems and tools available but are not requiring Medicare Advantage plans to submit data for accreditation purposes nor will any Medicare data be used in NCQA 2020 Health Plan Ratings. For commercial and Medicaid plans that are NCQA accredited, we also are letting plans report their 2018 measurement year results for hybrid measures if they are better than 2019 hybrid results due to difficulties in accessing clinician offices for manual chart retrieval with no questions asked.
We are very pleased that a majority of plans did choose to continue reporting for internal quality improvement purposes. Many plan staff who work on quality reporting are not on the front lines of the crisis and are instead continuing to work their regular jobs remotely, as are NCQA staff. The results may provide valuable lessons for responding to future crises.
We also greatly appreciate that as of now CMS intends to maintain measurement year 2020 reporting in June of 2021. While the pandemic will clearly have an impact on results, it is crucial to not miss out on another year or fail to assess the pandemic’s impact on quality so that recovery from it can also be assessed. It also would be unwise to indefinitely continue posting ratings and providing bonuses and rebates based on measurement year 2018 results. Enrollees deserve up to date quality ratings as soon as they are feasible to make informed decisions. Plans that have worked diligently to improve their scores deserve the rewards and recognition they have earned.
We further support the policy of removing guardrails for 2022 that would have kept cut points from dropping more than 5%. Given the drastic decrease in preventive services and office visits during the pandemic, it is almost certain that performance on some measures will decrease by more than 5%.
Thank you for the opportunity to share our thoughts and for your heroic efforts to stem the COVID-19 crisis. If you have any questions please contact NCQA Director of Federal Affairs, Paul Cotton, at (202) 955-5162 or firstname.lastname@example.org.
Margaret E. O’Kane
1 All NCQA policy changes related to the COVID-19 pandemic are posted at https://www.ncqa.org/covid/.
2 HEDIS, the Healthcare Effectiveness Data & Information Set, is a registered trademark of NCQA.
3 The Doctor Will Zoom You Now, Wall Street Journal, April 26, 2020.