Bylaws: Physician-Focused Payment Model Technical Advisory Committee

Physician-Focused Payment Model Technical Advisory Committee

Bylaws

Approved and adopted as revised by PTAC on May 25, 2018

 

The following Bylaws and Operating Procedures (“Bylaws”) will govern the operations of the Physician-Focused Payment Model Technical Advisory Committee (the Committee).

Section I: Purpose.

The purpose of the Committee is to:

  1. Review proposals submitted by individuals and stakeholder entities for physician-focused payment models (PFPMs); and

  2. Provide comments and recommendations to the Secretary of Health and Human Services (the Secretary) regarding whether each proposal meets criteria for PFPMs established by the Secretary.

Section II: Authority.

The Committee was created by Congress at section 101(e)(1) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and is subject to the Federal Advisory Committee Act (FACA), as outlined in its Charter, filed with the Congress on January 5, 2016.

Section III: Committee Structure and Scope.

The Committee shall be structured and operate in accord with its Charter. 

Section IV: Role of Committee Officials and Members.

A. Designated Federal Officer (DFO). Consistent with the duties of the DFO specified in 41 CFR Part 102-3.120 and the Committee’s charter, the DFO shall:

  1. approve or call all meetings of the Committee and subcommittees;

  2. approve Committee meeting and subcommittee agendas.  The DFO will consult with the Chair, Vice Chair and Committee members prior to final approval of the agendas;

  3. attend all meetings;

  4. adjourn Committee and subcommittee meetings when the DFO determines such adjournment is in the public interest;

  5. chair meetings of the Committee in the absence of the Chair and Vice Chair;

  6. ensure the preparation of the minutes of all meetings of the Committee's deliberations, including any subcommittee activities;

  7. maintain official Committee records and records of all meetings;

  8. prepare and manage all reports, including the annual report as required by FACA; and

  9. designate a ‘DFO alternate’ to serve in the role of DFO when the DFO is unable to attend a scheduled Committee or subcommittee meeting.

B. Committee Chair.  The Committee Chair shall:

  1. Work with the DFO and Vice Chair to:

    1. identify and prioritize issues to be addressed by the Committee,

    2. schedule meetings as necessary to carry out the work of the Committee, and

    3. develop proposed agenda items for Committee meetings with input from the Committee Members;

  2. Preside at and conduct all Committee meetings in accord with the published agenda.  In the absence of the Chair, the Vice Chair will serve as Chair.  In the absence of the Chair and Vice Chair, the Chair will appoint either a Committee member or the DFO to preside and conduct the meeting in accord with the published agenda;

  3. Ensure that all rules of order and conduct are maintained during each session;

  4. Call on individuals for opinions and comments, terminate any discussion which is felt to be unnecessary, and call for a vote, if required or requested by Committee Members;

  5. Manage public participation during the open portion of meeting;

  6. Certify the accuracy of the minutes of each Committee meeting within 90 days after the meeting has been held; and

  7. Appoint Committee Members to Subcommittees as needed to efficiently carry out the work of the Committee.

C. Vice Chair.  The Committee Vice Chair shall:

  1. Work with the Chair and DFO to:

a. identify and prioritize issues to be addressed by the Committee;

b. schedule meetings as necessary to carry out the work of the Committee, and

c. develop proposed agenda items for Committee meetings with input from the Committee members; and

  1. In the absence of the Chair, carry out the duties detailed in Section IV. B.2-7 above.

D. Committee Members.  Committee members shall:

  1. Serve as a source of independent expertise and advice on matters addressed by the Committee as described in the Committee charter;

  2. Make every effort to attend scheduled meetings of the full Committee in their entirety  and, as appropriate, any meetings of Subcommittees of which he/she is a member; and notify the DFO or other designated official, well in advance, of any changes in personal schedule that may prevent his/her presence at all or part of a scheduled meeting;

  3. Review required material before meetings to allow effective discussion, commenting, and voting on issues brought before the Committee;

  4. Make recommendations on proposals brought to the Committee in the manner prescribed by the Committee; 

  5. Serve on Subcommittees at the request of the Chair or Vice-Chair;

  6. Read, understand and adhere to provisions related to conflicts of interest, ethics, and confidentiality and, as appropriate, complete necessary forms relating to these areas;

  7. Protect and maintain as confidential any privileged information;

  8. Refrain from discussing outside of the Committee meetings information obtained during any closed sessions; and

  9. Complete necessary paperwork to ensure compensation for approved travel.

Section V: Ethics.

A. Committee Member Disclosures.

  1. Disclosures to the Comptroller General of the United States. As directed by the section 101(e)(1) of MACRA, Committee members shall disclose any financial or other potential conflicts of interest in accord with the system for public disclosure developed by the Comptroller General of the United States.

  2. Disclosures to the Committee.  Prior to participating in any review, deliberation voting, or other Committee work related to a PFPM submitted to the Committee, Committee members shall disclose to the Committee in writing:

    1. any role they have played in the development of  the submitted PFPM;

    2. any prior personal or professional relationship with the person or organization submitting the PFPM; and 

    3. any impact that such a PFPM could have on them if it were approved.

All disclosures made under this section shall be reviewed by the Committee according to the procedures described in sections V. B and V.C, below, to identify any Committee member partiality and/or potential conflicts of interest, and to identify and implement appropriate remedies when any such partiality or conflict of interest is identified.

  1. Disclosures to the Public.  At the beginning of each meeting at which the Committee is to deliberate and/or vote on a submitted PFPM, Committee members shall orally read their written PFPM-specific disclosures made in accord with Section V.A.2., above so that it is presented to the public and captured in any meeting transcript.  

B. Determination of Existence and Extent of Conflict of Interest and Appropriate Remedy. As directed by the MACRA, Committee members are chosen based on national recognition for their expertise in PFPMs and related delivery of care. MACRA also permits some Committee members to be providers of services or representatives of providers of service.  Because of this combination of expertise and connection to service providers, it is anticipated that some Committee members may have been involved in the development of proposed PFPMs or may be affected by proposed PFPMs if they are approved and implemented.

Further, although the Committee has been instructed (as of the date of the Committee’s enactment on January 5, 2016) that Committee members have been determined to be neither employees of the Executive branch of the federal government nor “special government employees,” the Committee has determined that it will act to the extent practicable in accord with provisions of federal rules at 5 CFR 2640.203(g) governing the activities of special government employees serving on advisory committees. The Committee seeks to do so in order to set high standards for ethical practice and impartiality in its work. To fulfill this goal, the Committee will operate in accord with the following procedures: 

  1. Each Committee member will make the disclosures to the Committee specified in section V.A.2., above.

  2. The Committee shall make decisions on a case-by-case basis about the extent to which a Committee member with any disclosed information should participate in review, deliberation, voting, or making any recommendation on the PFPM submitted to the Committee.

  3. Committee decisions about member involvement in PFPMs submitted to the Committee shall be as follows:

    1. A member shall be permitted to recuse himself or herself from any review, deliberation or voting on a PFPM at that member’s sole discretion;

    2. Consistent with 5 CFR 2640.203(g), a member generally will be permitted to participate in discussions and/or actions where a conflict of interest arises from an employment or consulting arrangement as long as the matter under discussion will not have a special or distinct effect on the individual other than as part of a class.

    3. In general, Committee members also will be permitted to participate in discussions and/or actions where conflicts of interest existed in the past but there are no current or planned financial or contractual relationships that would create a potential for financial conflict in the future.

    4. When information indicates that a member’s involvement in a PFPM or impact of a PFPM on that member could be a conflict, the Committee will evaluate the extent of the involvement or impact and make a determination as to the appropriate level of participation by that Committee Member in the Committee’s actions regarding the matter.  This could include:

      1. authorizing full participation by the Member in Committee / Subcommittee discussions and voting,

      2. permitting participation by the Member in Committee discussions and voting, but not on a Subcommittee making recommendations to the Committee,

      3. permitting participation by the Member in Committee discussion on the matter but requiring the Member be recused from voting, or

      4. requiring recusal of the Member from both discussion and voting on the matter. 

  1. Committee decisions described in 3, above, shall be made by the Committee Chair polling at a meeting or administrative session each member present to determine each member’s recommendation on the extent to which a member under question should participate in the review, deliberations and recommendations pertaining to a PFPM.  Committee decisions shall be made by a vote by all Committee members in attendance at the meeting/administrative session.  The Committee’s decision shall be that representing at least a two-thirds supermajority of votes of committee members in attendance. The Committee’s decision shall be reported in the Committee’s public FACA files.

  2. The Member’s involvement and potential impact of the proposed PFPM on the Member, and the Committee’s decision with respect to the Member’s participation in deliberations and recommendations shall be disclosed to the public at each meeting at which the proposal is discussed.

  3. The Committee shall review this Section of the bylaws (Section V. Ethics) at six months intervals to determine the need to make any modifications

C. Determination of Existence and Extent of Partiality and Appropriate Remedy. In addition to consideration of potential conflicts of interest as addressed in V. B., above, there may be other circumstances which — although not constituting a financial conflict of interest — may raise questions regarding a member's impartiality in the review, deliberations or voting on a particular PFPM or other matter.  For example, a committee member may have a prior personal or professional relationship with a person or organization submitting a PFPM, or may have had prior involvement with a PFPM. In such circumstances, the committee member’s relationship or involvement shall be disclosed in accord with section V.A. and discussed by the Committee. Following this discussion and using the same provisions in these bylaws pertaining to the handling of potential conflicts of interest, the Committee shall make a determination, in accordance with the provisions of V.B. and D., as to whether the member may participate in the review, deliberations, and voting pertaining to the matter in question. (Adapted from: “Ethics Rules for Advisory Committee Members and Other Individuals Appointed as Special Government Employees (SGEs),” Office of the General Counsel, Ethics Division, 2004)

D. Procedures for Recusal. When the Committee has determined that a Committee Member should be recused from participation in a Committee discussion because of a conflict of interest or risk of partiality, the DFO shall ensure that the Member does not participate in the discussion or physically leaves the room during the discussion  (whichever is specified in the Committee’s decision about recusal), and shall ensure that the minutes and transcript clearly indicate that the member did not participate and/or was not present during the discussion. When the Committee has determined that a Committee member should be recused from participation in a vote but not the discussion preceding the vote, the DFO shall ensure that the member does not participate in the vote or physically leaves the room during the vote (whichever is specified in the Committees decision about the recusal).

E. Communications Regarding Committee Processes and Deliberations.

  1. With the exception of Committee Member discussions taking place as part of Committee meetings, Committee Members shall refrain from discussing with members of the public any PFPM that is pending submission to the Committee or has been submitted to the Committee.

  2. With the exception of Committee Member discussions taking place with a submitter as part of Committee meetings or as part of a meeting of a subcommittee charged with reviewing a proposal, Committee Members shall refrain from discussing with a submitter of a proposed model:

    1. the submitter’s PFPM (or information related to the PFPM) that is pending submission to the Committee or has been submitted to the Committee, unless the Member has announced to the submitter and the Committee his or her recusal from Committee review, deliberation and voting on the submitted model.

    2. the Committee’s processes surrounding the Committee’s receipt, review, deliberation and voting on the submitter’s PFPM that is pending submission to the Committee or has been submitted to the Committee.

  3. Committee Members shall refer all questions or requests for information or discussion from model submitters and the public about a submitted proposal or the Committee’s work on submitted proposals to the Committee’s public mailbox. Committee staff will work with the Committee Chair and Vice Chair to determine the best approach to respond to the submitted questions and requests for information or discussion.

Section VI: Committee Meetings: The Committee will meet as often as necessary to timely complete its work. Meetings will be called by the DFO in consultation with Committee Chair and Vice Chair and operate as follows:

  1. Quorum.  No meeting shall be held in the absence of a quorum.  A quorum is a majority of the Committee’s appointed membership.  (The quorum is six members if all eleven members have been appointed.)

  2. DFO attendance. The DFO or the alternate DFO designated by the DFO must be present at each Committee meeting.

  3. Agenda. Each meeting of the Committee shall be conducted in accordance with an agenda approved by the DFO. The DFO will distribute the agenda to the Members prior to each meeting and will publish an outline of the agenda with the notice of the meeting in the Federal Register. Items for the agenda may be submitted to the DFO and/or the Chairman by any member of the Committee.

  4. Minutes and Records. The DFO will prepare minutes of each meeting and will distribute copies to each Committee member. Minutes of open meetings will be available to the public upon request. Minutes of closed meetings will also be available to the public upon request, subject to the withholding of matters about which public disclosure would be harmful to the interests of the Government, industry, or others, and which are exempt from disclosure under the Freedom of Information Act (FOIA). The minutes will include a record of the persons present (including the names of Committee members, names of staff, and the names of members of the public from whom written or oral presentations were made) and a complete and accurate description of the matters discussed and conclusions reached, and copies of all reports received, issued or approved by the Committee. All documents, reports, or other materials prepared by, or for, the Committee constitute official government records and must be maintained according to Unites States General Services Administration policies and procedures governing FACA committees.

  5. Committee Deliberations. Committee deliberations on PFPMs, evidence pertaining to such models and proposals, and comments and recommendations regarding such proposals including whether such models meet criteria established by the Secretary for PFPMs, shall be open to the public, except where a closed or partially-closed meeting has been determined proper and consistent with the exemption(s) of the Government in the Sunshine Act, 5 U.S.C. 552b(c), as the basis for closure.

  6. Committee Decision-Making.  Committee decision-making (other than that described in section V, B above, on Ethics) will include both decisions on recommending a PFPM model to the Secretary, and other decisions which will be considered procedural decisions.

    1. Committee decisions on recommendations to be made to the Secretary shall be made in accord with the procedures established by the Committee regarding proposal review.

    2. Other procedural decisions will be made by the Chair first seeking to determine if consensus exists on the question under discussion.  If consensus does not exist, the Chair will request a motion for a vote.  Any member, including the Chair, may make a motion for a vote.  No second after a proper motion will be required to bring any issue to a vote.  If a quorum exists, a majority vote of the members present will be sufficient to approve a motion.

  7. Openness. In compliance with the provisions of the Federal Advisory Committee Act (FACA), unless otherwise determined in advance, all meetings of the Committee will be open to the public and follow relevant policies and procedures of FACA as specified in the Code of Federal Regulations at 41 CFR Parts 101-6. All materials brought before, or presented to, the Committee during the conduct of an open meeting, including the minutes of the proceedings of an open meeting, will be available to the public for review no later than seven days after the meeting.

Members of the public may attend any meeting or portion of a meeting that is not closed to the public and may, at the determination of the Chair or acting Chair, offer oral comment at such meeting.  Members of the public may be asked to preregister for the meeting and reasonable accommodations will be provided to those members of the public needing such accommodations.  If the number of meeting registrants exceeds the seating capacity of the meeting location, a wait list will be created and other options such as a teleconference line may be provided.  The Chair or DFO may decide in advance to exclude oral public comment during a meeting, in which case the meeting announcement published in the Federal Register will note that oral comment from the public is excluded and will invite written comment as an alternative. Members of the public may submit written statements to the DFO at any time.

  1. Closed Meetings. Meetings of the Committee will be closed only in limited circumstances and in accordance with applicable law. In addition, requests for closed meetings must be approved by GSA's Office of General Counsel (OGC) 30 days in advance of the session. Where the DFO has determined in advance that discussions during a Committee meeting will involve matters about which public disclosure would be harmful to the interests of the government, industry, or others, an advance notice of a closed meeting, citing the applicable exemptions of the Government in the Sunshine Act (GISA), will be published in the Federal Register. The notice may announce the closing of all or just part of a meeting. If, during the course of an open meeting, matters inappropriate for public disclosure arise during discussions, the Chairman, Acting Chair, or DFO will order such discussion to cease and will schedule it for closed session. Notices of closed meetings will be published in the Federal Register at least 15 calendar days in advance.

  2. Subcommittees.  Subcommittees may be established with the approval of the Secretary of HHS or designee to address specific issues.  Subcommittee members will be composed of Committee Members.  A majority of the appointed Subcommittee members shall constitute a quorum and no Subcommittee shall meet unless a quorum of the Subcommittee is present. The work of the Subcommittees will be directed by the Chair.  Subcommittees may convene or communicate in person or via any combination of teleconference, videoconference, or email.  Subcommittees will make their recommendations to the full Committee for deliberation; no action by a Subcommittee will be considered an action by the Committee unless it has been approved by the full Committee. The DFO or the alternate DFO designated by the DFO must be present at each subcommittee meeting. If simultaneous subcommittee meetings are to be held, each subcommittee shall have a DFO or alternate DFO in attendance.

Section VII: Staff Support

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services is responsible for the provision of technical and operational support for the Committee, which may occur through the use of a contractor. The Office of the Actuary of the Centers for Medicare and Medicaid Services shall provide actuarial assistance to the Committee as needed.

Section VIII: Amendments

These Bylaws may be amended as needed by a vote of the members of the Committee.  A simple majority vote in favor of amending the bylaws shall constitute of approval of the amendment.