Confirmation Delay for Next CMS Administrator Could Cause Problems for Home-Based Care Providers

It has been over three months since former Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma resigned from her post. As of Wednesday, no one has officially filled the position’s void.

The Biden administration’s pick for administrator, Chiquita Brooks-LaSure, has yet to be confirmed by the Senate due to ongoing partisan disputes. For context, Verma was confirmed on March 13 of 2017 — over a month ahead of Brooks-LaSure’s current timeline.

The delay has home-based care insiders at least slightly concerned, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.


“This is a very important time for CMS to be fully staffed, including the administrator,” Dombi told Home Health Care News in an email. “While Acting Administrator [Liz] Richter is highly skilled, it is essential that the permanent administrator be in place to ensure that decisions and actions occur expeditiously.”

Richter, who has been with CMS since 1990, is filling in until Brooks-LaSure’s confirmation.

Sen. John Cornyn (R-Texas) is one the lawmakers that is making the confirmation more difficult. His office told The Hill that the senator is doing so because of the recent withdrawal of Texas’s Medicaid waiver.


The withdrawal of Texas’s Medcaid waiver last week — a rescinding of funds from the federal government — is a move to coerce the state into expanding Medicaid under the Affordable Care Act (ACA), Republicans believe.

“Senator Cornyn placed the hold after the Biden administration decided to play political chicken with uninsured Texans’ health care,” a Cornyn spokesperson told The Hill. “He’s requested additional information from the nominee and the administration about how they plan to ensure our most vulnerable Texans don’t lose their health care because of their actions.”

Cornyn’s ploy can merely slow down the confirmation process, because Democrats will only need 50 votes to push Brooks-LaSure through.

The Biden administration claimed that the waiver was rescinded because the former administration skipped the public comment period when granting the waiver, but it’s still unclear if there were ulterior motives.

The waiver was granted in the waning days of Donald Trump’s presidency and gave Texas federal funds to reimburse health care providers after caring for uninsured individuals. Because Brooks-LaSure has not yet been confirmed, she did not have anything to do with the Medicaid waiver withdrawal.

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

“Many CMS actions are still moving along the normal schedule, such as annual payment rules,” Dombi said. “However, a full team is needed at CMS to address many of the unique issues that have to be addressed, including the recent American Rescue Act that includes the 10% increase in FMAP for Medicaid HCBS.”

Many health care initiatives have been delayed since the Biden administration took over, whether it was its own doing or someone else’s.

The Center for Medicare & Medicaid Innovation (CMMI), for instance, has paused direct-contracting models that were supposed to launch in a larger style this year. On the hospice side, CMS elected to delay the implementation of the Primary Care First Serious Illness Population payment model.

Delays will likely persist even longer if all hands are not on deck at CMS.

“A full team at CMS is in the best interests of patients and providers,” Dombi said.

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