As Becerra Awaits HHS Confirmation, Biden Reportedly Narrows Picks to Head CMS

There’s a new name being circulated for President Joe Biden’s top pick to lead the U.S. Centers for Medicare & Medicaid Services (CMS).

Chiquita Brooks-LaSure — a former policy official who played a key role in guiding the Affordable Care Act through passage and implementation — is now the likeliest candidate to run CMS, according to a POLITICO report. Brooks-LaSure is currently a managing director at consulting firm Manatt Health, where she helps clients understand regulatory and legislative policies related to Medicare, Medicaid and private insurance.

While Brooks-LaSure appears to have an edge, Mandy Cohen is also seen as a leading candidate to head CMS, POLITICO notes. Another health care leader linked to the Obama administration, Cohen currently serves as North Carolina’s health secretary.


So far, Biden’s decision on who will run the trillion-dollar CMS has been delayed by the slow-moving Senate confirmation of Xavier Becerra. Biden picked Becerra to head the U.S. Department of Health and Human Services (HHS) in early December, but his confirmation has been delayed due to power-sharing disputes among lawmakers and disagreements over the next round of COVID-19 relief.

Former HHS secretaries Kathleen Sebelius and Donna Shalala wrote in a recent op-ed that Congress is hindering the country’s ability to fully fight the coronavirus by slow-playing Becerra’s confirmation. 

“Without the secretary, we will face a backlog that will slow our national response to this crisis, upend progress already being made and prevent action when it is needed most,” they argued. “The Senate should move on this nomination as soon as possible and put in place this qualified nominee who can help keep us safe and healthy, end this crisis, and get us back to our lives.”


The current wave of new COVID-19 infections seems to be lessening, with the seven-day rolling average of new cases trending downward across much of the nation. After several days in early 2021 with more than 200,000 new cases, less than 137,000 new cases were reported for Feb. 3.

While the trend is encouraging, this winter’s daily numbers still eclipse peaks from the spring and summer. Additionally, acute care capacity remains a challenge, with roughly 72% of all in-patient beds occupied as of Feb. 1, according to HHS data.

“This is a crisis, and having each served as our nation’s top health official, we understand the critical importance of having a competent and effective team ready to solve it,” the op-ed from Sebelius and Shalala continues.

Whoever takes over CMS, they’ll inherit a lot more than the public health emergency.

For starters, there’s the ongoing shift toward value-based care and all the new payment arrangements coming out of CMS and its innovation center, including three different direct-contracting options. In the home health arena, the potential nationwide expansion of the Value-Based Purchasing Model and any recalibration to the Patient-Driven Groupings Model (PDGM) are two items the incoming CMS administrator will have to address soon, too.

There’s also, of course, the rebalancing of fee-for-service Medicare toward Medicare Advantage.

And that’s not to mention the challenge of figuring out fair reimbursement for health care services delivered virtually or the constant struggle of preventing fraud, waste and abuse amid skyrocketing health care spending.

On top of all those trends and challenges, the pandemic has also exposed deep cracks and tragic failings within the U.S. long-term care system, from nursing homes to home- and community-based services. Prior to leaving her post, former CMS Administrator Seema Verma openly pointed to how the country leans too heavily on nursing homes for long-term care.

“The tragic devastation wrought by the coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” Verma said after CMS freed up $165 million for Money Follows the Person (MFP) programs. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”

It will be interesting to see if her replacement shares those views.

The consulting firm Brooks-LaSure works for, Manatt, was commissioned in the spring of 2020 to perform the first comprehensive analysis of the failures of nursing home infrastructure in New Jersey amid COVID-19.

The pandemic has also highlighted health disparities among certain populations. That’s a point Brooks-LaSure has recently addressed herself.

Brooks-LaSure was quoted in PatientEngagementHIT discussing the maternal health care inequities faced by Black and other minority mothers. She additionally co-authored an article related to state strategies for overcoming barriers to advance health equity.

“While states are taking unprecedented steps in the right direction, they are still grappling with the challenges of advancing health equity, which can at times feel insurmountable,” the article reads. “Engaging in honest conversation, both internally with state leaders and staff as well as with communities impacted by inequities, is critical to identifying barriers to equity and taking concrete action steps to remove them.”

CMS veteran Liz Richter has been serving as the agency’s acting director until there’s an official replacement for Verma, who served under the Trump administration from March 2017 until resigning on Jan. 20. Richter has held various positions at CMS since 1990.

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