Presidential DocumentExecutive Order 138902019-22073
Protecting and Improving Medicare for Our Nation's Seniors
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Published
October 8, 2019
Signed
October 3, 2019
Issuing agencies
Executive Office of the President
Full Text
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<title>Federal Register, Volume 84 Issue 195 (Tuesday, October 8, 2019)</title>
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[Federal Register Volume 84, Number 195 (Tuesday, October 8, 2019)]
[Presidential Documents]
[Pages 53573-53576]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2019-22073]
Presidential Documents
Federal Register / Vol. 84 , No. 195 / Tuesday, October 8, 2019 /
Presidential Documents
___________________________________________________________________
Title 3--
The President
[[Page 53573]]
Executive Order 13890 of October 3, 2019
Protecting and Improving Medicare for Our
Nation's Seniors
By the authority vested in me as President by the
Constitution and the laws of the United States of
America, it is hereby ordered as follows:
Section 1. Purpose. The proposed Medicare for All Act
of 2019, as introduced in the Senate (``Medicare for
All'') would destroy our current Medicare program,
which enables our Nation's seniors and other vulnerable
Americans to receive affordable, high-quality care from
providers of their choice. Rather than upend Medicare
as we know it, my Administration will protect and
improve it.
America's seniors are overwhelmingly satisfied with
their Medicare coverage. The vast majority of seniors
believe that the program delivers high-quality health
outcomes. Medicare empowers seniors to choose their own
providers and the type of health insurance that works
best for them, whether it is fee-for-service (FFS)
Medicare, in which the Federal Government pays for
covered services, or Medicare Advantage (MA), in which
Medicare dollars are used to purchase qualified private
health insurance. ``Medicare for All'' would take away
the choices currently available within Medicare and
centralize even more power in Washington, harming
seniors and other Medicare beneficiaries. Throughout
their lives, workers and their employers have
contributed their own money to the Medicare Trust Fund.
It would be a mistake to eliminate Americans'
healthcare choices and to force them into a new system
that is effectively a Government takeover of their
healthcare.
``Medicare for All'' would not only hurt America's
seniors, it would also eliminate health choices for all
Americans. Instead of picking the health insurance that
best meets their needs, Americans would generally be
subject to a single, Government-run system. Private
insurance for traditional health services, upon which
millions of Americans depend, would be prohibited.
States would be hindered from offering the types of
insurance that work best for their citizens. The
Secretary of Health and Human Services (Secretary)
would have the authority to control and approve health
expenditures; such a system could create, among other
problems, delays for patients in receiving needed care.
To pay for this system, the Federal Government would
compel Americans to pay more in taxes. No one--neither
seniors nor any American--would have the same options
to choose their health coverage as they do now.
Instead of ending the current Medicare program and
eliminating health choices for all Americans, my
Administration will continue to protect and improve
Medicare by building on those aspects of the program
that work well, including the market-based approaches
in the current system. The MA component, for example,
delivers efficient and value-based care through choice
and private competition, and has improved aspects of
the Medicare program that previously failed seniors.
The Medicare program shall adopt and implement those
market-based recommendations developed pursuant to
Executive Order 13813 of October 12, 2017 (Promoting
Healthcare Choice and Competition Across the United
States), and published in my Administration's report on
``Reforming America's Healthcare System Through Choice
and Competition.'' Doing so would help empower patients
to select and access the right care, at the right time,
in the right place, from the right provider.
[[Page 53574]]
Sec. 2. Policy. It is the policy of the United States
to protect and improve the Medicare program by
enhancing its fiscal sustainability through alternative
payment methodologies that link payment to value,
increase choice, and lower regulatory burdens imposed
upon providers.
Sec. 3. Providing More Plan Choices to Seniors. (a)
Within 1 year of the date of this order, the Secretary
shall propose a regulation and implement other
administrative actions to enable the Medicare program
to provide beneficiaries with more diverse and
affordable plan choices. The proposed actions shall:
(i) encourage innovative MA benefit structures and plan designs, including
through changes in regulations and guidance that reduce barriers to
obtaining Medicare Medical Savings Accounts and that promote innovations in
supplemental benefits and telehealth services;
(ii) include a payment model that adjusts supplemental MA benefits to allow
Medicare beneficiaries to share more directly in the savings from the
program, including through cash or monetary rebates, thus creating more
incentives to seek high-value care; and
(iii) ensure that, to the extent permitted by law, FFS Medicare is not
advantaged or promoted over MA with respect to its administration.
(b) The Secretary, in consultation with the
Chairman of the Council of Economic Advisers, shall
submit to the President, through the Assistants to the
President for Domestic and Economic Policy, a report
within 180 days from the date of this order that
identifies approaches to modify Medicare FFS payments
to more closely reflect the prices paid for services in
MA and the commercial insurance market, to encourage
more robust price competition, and otherwise to inject
market pricing into Medicare FFS reimbursement.
Sec. 4. Improving Access Through Network Adequacy.
Within 1 year of the date of this order, the Secretary
shall propose a regulation to provide beneficiaries
with improved access to providers and plans by
adjusting network adequacy requirements for MA plans to
account for:
(a) the competitiveness of the health market in the
States in which such plans operate, including whether
those States maintain certificate-of-need laws or other
anti-competitive restrictions on health access; and
(b) the enhanced access to health outcomes made
possible through telehealth services or other
innovative technologies.
Sec. 5. Enabling Providers to Spend More Time with
Patients. Within 1 year of the date of this order, the
Secretary shall propose reforms to the Medicare program
to enable providers to spend more time with patients
by:
(a) proposing a regulation that would eliminate
burdensome regulatory billing requirements, conditions
of participation, supervision requirements, benefit
definitions, and all other licensure requirements of
the Medicare program that are more stringent than
applicable Federal or State laws require and that limit
professionals from practicing at the top of their
profession;
(b) proposing a regulation that would ensure
appropriate reimbursement by Medicare for time spent
with patients by both primary and specialist health
providers practicing in all types of health
professions; and
(c) conducting a comprehensive review of regulatory
policies that create disparities in reimbursement
between physicians and non-physician practitioners and
proposing a regulation that would, to the extent
allowed by law, ensure that items and services provided
by clinicians, including physicians, physician
assistants, and nurse practitioners, are appropriately
reimbursed in accordance with the work performed rather
than the clinician's occupation.
Sec. 6. Encouraging Innovation for Patients. Within 1
year of the date of this order, the Secretary shall
propose regulatory and sub-regulatory changes to the
Medicare program to encourage innovation for patients
by:
[[Page 53575]]
(a) streamlining the approval, coverage, and coding
process so that innovative products are brought to
market faster, and so that such products, including
breakthrough medical devices and advances in telehealth
services and similar technologies, are appropriately
reimbursed and widely available, consistent with the
principles of patient safety, market-based policies,
and value for patients. This process shall include:
(i) adopting regulations and guidance that minimize and eliminate, as
appropriate, the time and steps between approval by the Food and Drug
Administration (FDA) and coverage decisions by the Centers for Medicare and
Medicaid Services (CMS);
(ii) clarifying the application of coverage standards, including the
evidence standards CMS uses in applying its reasonable-and-necessary
standard, the standards for deciding appeals of coverage decisions, and the
prioritization and timeline for each National Coverage Determination
process in light of changes made to local coverage determination processes;
and
(iii) identifying challenges to the use of parallel FDA and CMS review and
proposing changes to address those challenges; and
(b) modifying the Value-Based Insurance Design
payment model to remove any disincentives for MA plans
to cover items and services that make use of new
technologies that are not covered by FFS Medicare when
those items and services can save money and improve the
quality of care.
Sec. 7. Rewarding Care Through Site Neutrality. The
Secretary shall ensure that Medicare payments and
policies encourage competition and a diversity of sites
for patients to access care.
Sec. 8. Empowering Patients, Caregivers, and Health
Providers. (a) Within 1 year of the date of this order,
the Secretary shall propose a regulation that would
provide seniors with better quality care and cost data,
improving their ability to make decisions about their
healthcare that work best for them and to hold
providers and plans accountable.
(b) Within 1 year of the date of this order, the
Secretary shall use Medicare claims data to give health
providers additional information regarding practice
patterns for services that may pose undue risks to
patients, and to inform health providers about practice
patterns that are outliers or that are outside
recommended standards of care.
Sec. 9. Eliminating Waste, Fraud, and Abuse to Protect
Beneficiaries and Taxpayers. (a) The Secretary shall
propose regulatory or sub-regulatory changes to the
Medicare program, to take effect by January 1, 2021,
and shall propose such changes annually thereafter, to
combat fraud, waste, and abuse in the Medicare program.
The Secretary shall undertake all appropriate efforts
to direct public and private resources toward detecting
and preventing fraud, waste, and abuse, including
through the use of the latest technologies such as
artificial intelligence.
(b) The Secretary shall study and, within 180 days
of the date of this order, recommend approaches to
transition toward true market-based pricing in the FFS
Medicare program. The Secretary shall submit the
results of this study to the President through the
Assistants to the President for Domestic and Economic
Policy. Approaches studied shall include:
(i) shared savings and competitive bidding in FFS Medicare;
(ii) use of MA-negotiated rates to set FFS Medicare rates; and
(iii) novel approaches to information development and sharing that may
enable markets to lower cost and improve quality for FFS Medicare
beneficiaries.
Sec. 10. Reducing Obstacles to Improved Patient Care.
Within 1 year of the date of this order, the Secretary
shall propose regulatory changes to the Medicare
program to reduce the burden on providers and eliminate
regulations that create inefficiencies or otherwise
undermine patient outcomes.
[[Page 53576]]
Sec. 11. Maximizing Freedom for Medicare Patients and
Providers. (a) Within 180 days of the date of this
order, the Secretary, in coordination with the
Commissioner of Social Security, shall revise current
rules or policies to preserve the Social Security
retirement insurance benefits of seniors who choose not
to receive benefits under Medicare Part A, and propose
other administrative improvements to Medicare
enrollment processes for beneficiaries.
(b) Within 1 year of the date of this order, the
Secretary shall identify and remove unnecessary
barriers to private contracts that allow Medicare
beneficiaries to obtain the care of their choice and
facilitate the development of market-driven prices.
Sec. 12. General Provisions. (a) Nothing in this order
shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency, or
the head thereof; or
(ii) the functions of the Director of the Office of Management and Budget
relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with
applicable law and subject to the availability of
appropriations.
(c) This order is not intended to, and does not,
create any right or benefit, substantive or procedural,
enforceable at law or in equity by any party against
the United States, its departments, agencies, or
entities, its officers, employees, or agents, or any
other person.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
(Presidential Sig.)
THE WHITE HOUSE,
October 3, 2019.
[FR Doc. 2019-22073
Filed 10-7-19; 8:45 am]
Billing code 3295-F0-P
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</html>Indexed from Federal Register on October 8, 2019.
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