Acting CMS Chief Seen as Unlikely to Keep Post in New Administration

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By Nathaniel Weixel

Aug. 17 — Hillary Clinton's campaign has announced the establishment of her presidential transition team, which will begin laying the groundwork for executive branch appointments—including health-care officials.

One high-ranking position that likely will need to be filled is that of CMS administrator. Andy Slavitt was named acting administrator of the Centers for Medicare & Medicaid Services in February 2015. Former public officials told Bloomberg BNA that it's unlikely that he would continue serving in his current position in a new Democratic administration, but he probably would work through the lame duck transition period from November to January. The Medicare program is in the middle of some major changes, and Slavitt has spoken of his desire to set the policy stage for his successor.

The CMS has had an ambitious agenda in 2016. The Meaningful Use program will be replaced with a new, more flexible system for electronic health standards. In addition, doctors are seeing a massive payment system transformation under the Medicare Access and CHIP Reauthorization Act (MACRA), which aims to shift to value-based payments.

A new administration will likely want to “reshuffle” the agency, Dan Mendelson, president and CEO of the consulting firm Avalere Health, said, and Slavitt could choose to stay through the transition to help keep things smooth. And under a Republican administration, Mendelson noted it would be extremely unlikely for the CMS leader to stay on.

A 2010 law, known as the Pre-Election Transition Act, formalized the process for the transfer of powers from one administration to the next, and provided new resources to both party nominees so that they each could take steps ahead of the general election to ensure a seamless transition, according to a Clinton campaign announcement Aug. 16. “In keeping with the law, the Obama administration will host initial, transition planning meetings with representatives of both the Trump and Clinton campaigns,” the Clinton campaign statement added.

Seeking a Smooth Transition

“MACRA is really fundamental to the future of physician practice, and the present crew [at CMS] is really focused on that,” Mendelson said in an Aug. 17 interview. If Clinton wins the election, “the present team is going to do everything possible to ensure smooth transition.” Mendelson was associate health director at the White House Office of Management and Budget from 1998 to 2000.

If Slavitt were to stay through the transition process, it would be a “gift” to the new administration, Mendelson said. “These jobs are tiring. His presence would smooth things out a lot,” he said.

Gail Wilensky, a former leader of the CMS's predecessor agency, downplayed the impact of Medicare's changes on the transition process.

“That’s how Medicare is—it always has big changes going on. I don’t think that would be enough to persuade someone who wasn’t inclined to” stay on at a senior level, Wilensky told Bloomberg BNA Aug. 16.

Wilensky said there are typically very few appointees who stay through to a new administration, even within the same party.

“The expectation should be if you’re a political appointee and your term ends, you’ll be finding a new job,” she said.

Wilensky, health economist and senior fellow at Project HOPE, was head of the Health Care Financing Administration, the precursor to the CMS, from 1990 to 1992.

Confirmation Process

Slavitt replaced Marilyn Tavenner, who was confirmed as administrator by the Senate in a May 2013 vote of 91-7. Tavenner was generally well-liked by Republicans, and she was seen as someone who could rise above the politics of the Affordable Care Act. That led to her being the first administrator to be confirmed by the Senate since Mark McClellan left the agency in 2006.

Slavitt hasn't been confirmed, which could make it easier for the next administration to replace him, Mendelson said.

If Clinton appoints a new head of the CMS, Mendelson said he would expect Slavitt to get a senior-level job in the administration that doesn't require confirmation.

“The new administration won't try to bang their heads against a wall to try to get someone confirmed” who wasn’t able to get through the process previously, Mendelson said.

Wilensky said it's important that the next administrator to be confirmed.

“It's not the ideal way for the agency to be run” because an acting administrator may not have the same impact on Congress as someone who has been confirmed, Wilensky said.

However, Wilensky noted the CMS has shown it can function without a confirmed administrator.

“It’s a real disadvantage not having a confirmed administrator, but unfortunately we’ve seen that happen a lot since 2006— more often than not,” Wilensky said. “It's not the ideal way for the agency to run, but it can manage.”

Both Mendelson and Wilensky said the situation could be different if Democrats win the Senate.

“This has been a Congress that’s been incredibly sluggish—passive aggressive—with respect to nominees,” Mendelson said. “If Clinton wins in landslide and Democrats take the Senate, it's possible [Slavitt] would be interested in the job and would have confirmation.”

To contact the reporter on this story: Nathaniel Weixel in Washington at nweixel@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

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