[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 [www.gpo.gov]
[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.
                
                
                    (Presidential Sig.)

                THE WHITE HOUSE,

                    October 3, 2019.

[FR Doc. 2019-22073
Filed 10-7-19; 8:45 am]
Billing code 3295-F0-P