CMS too burdened and focused on cost to be the epicenter of long-term care reform, experts say

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Henry Claypool
Henry Claypool

Most long-term care reforms rely on the Centers for Medicare & Medicaid Services for implementation, but the overburdened agency cannot manage all the needed changes in this area, according to a panel of experts.

The three panelists were all members of the Congressional Commission on Long-Term Care, which recently issued its recommendations on how to reform the nation's long-term services and supports system. Many of these recommendations would be spearheaded by CMS, said panel host Bob Cusack, the managing editor of The Hill newspaper. He asked whether CMS would even be able to handle all the proposed reforms without a “dramatically” increased administrative budget, considering it is also responsible for launching Affordable Care Act components such as the troubled federal online marketplace.

“For this to be successfully engaged … I think you probably need to think about another agency,” said Henry Claypool, executive vice president of the American Association of People with Disabilities.

One candidate to oversee long-term care reform might be the Administration for Community Living, which was created within the Department of Health and Human Services to help enact the long-term care component of the ACA. This part of the law was scrapped in January, but the ACL, or a new agency created along similar lines, might be a good option to take the pressure off CMS, Claypool suggested.

CMS not only is stretched thin, but its “preoccupation with bending the Medicare cost curve” also makes it a problematic driver of long-term care reform, he added.

The other panelists concurred.

“Very often we focus on CMS as the only engine of renewal and effort,” said Carol Raphael, vice chairman of the board at AARP. Noting that there are “many other arenas” that can drive change, she said the role that technology can play in changing the LTSS system has been underestimated.

Grace Marie Turner, president of public policy research organization the Galen Institute, agreed. She cautioned that putting the focus too much on regulation stifles the kind of innovation that will lead to more organic changes system-wide. 

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