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Daily News

April 07, 2021

The American Medical Association joined dozens of specialty physician groups and patient advocates on Wednesday (April 7) in asking CMS to delay its decision to require prior authorization for two service areas under the calendar year 2021 Medicare hospital outpatient prospective payment rule and to put off any future prior authorization policies until more data are collected.

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As the Biden administration works to draft guidance for industry around COVID-19 vaccine passports -- digital health passes that can provide proof of vaccination and be used by businesses to screen people for vaccination status -- digital health groups say they want the federal government to play an even bigger role in in the development process, specifically by creating a unifying set of standards for industry, providing funding for developers, and allowing some apps to link up with federal agencies so they can notify users of new and updated federal guidance.

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CMS tells Inside Health Policy it is actively considering Democratic leaders’ request for a special enrollment period (SEP) that would allow people getting fully subsidized COBRA under the American Rescue Plan to enroll in ACA coverage through healthcare.gov once their benefits wind down in September.

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HHS Secretary Xavier Becerra on Wednesday (April 7) said more than 528,000 Americans have enrolled in Affordable Care Act coverage in the 36 states that use healthcare.gov since the new special enrollment period (SEP) kicked off Feb. 15, including 322,000 from March 1 through March 31.

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Shortly after the Supreme Court put its work case requirements case on hold, the Biden administration revoked another two states’ Medicaid work requirement waivers Tuesday (April 6), bringing the total to four states for which CMS has rescinded the Trump-era 1115 waivers.

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Stakeholders are hoping to see methadone administration flexibilities continued after the COVID-19 public health emergency, a request that could be in reach after the Biden administration said last Thursday (April 1) it will review methadone treatment policies and develop recommendations to modernize them.

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April 06, 2021

The Democratic leaders of congressional health care committees are asking HHS to make sure consumers that receive the six months of fully subsidized COBRA coverage available under the American Rescue Plan can enroll in an Affordable Care Act plan once the COBRA benefits end.

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HHS Secretary Xavier Becerra faces a barrage of competing issues arising out of the pandemic, but children’s health care advocates’ priorities center around one central idea: thinking about kids first.

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The White House is expected to roll out the health care priorities for its two-part infrastructure package sometime this Spring, and the health piece potentially could move separately now that the Senate parliamentarian has agreed Democrats have another shot passing their priorities through a simple majority.

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The White House Office of Management and Budget is again reviewing two FDA tobacco rules that were pushed out in the last days of the Trump administration but then promptly withdrawn under President Joe Biden’s regulatory freeze.

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April 05, 2021

The Senate parliamentarian on Monday agreed that Democrats have at least one more shot at passing legislation via a simple majority this calendar year by revising the 2021 budget resolution.

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The Supreme Court temporarily suspended its review, pending another order to come, of the Medicaid work requirements that former President Donald Trump’s CMS approved for Arkansas and New Hampshire, the high court announced Monday (April 5).

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Medicare Payment Advisory Commission members signaled they will start looking into transparency and accountability of health care ownership during an informational session on private equity in health care Friday (April 2), saying these issues are not solely driven by private equity ownership in the health sector and can affect Medicare costs.

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Supplement industry lawyers say FDA has stepped up its oversight of dietary supplements and they predict that oversight will become even stronger under the Biden administration, but leading supplement lobbyists are optimistic that at the state level the strict chain of production approach used by California won’t spread to other states and could even be ratcheted back by courts in California.

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The global economic recovery will be aided by a stronger-than-expected rebound in global merchandise trade, the World Trade Organization said on Wednesday, but Director-General Ngozi Okonjo-Iweala warned the comeback remains uneven as vaccine distribution trails in significant swaths of the globe, urging countries to prioritize widespread vaccine access to ensure a strong, long-term recovery.

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Sources say the Biden administration is looking at the regulatory process to fix the so-called “family glitch” that has blocked millions of dependents from accessing Affordable Care Act credits, a move pushed by beneficiary advocates, hospitals and other stakeholders.

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April 02, 2021

The U.S. Office of Special Counsel, an independent federal investigative agency, told President Joe Biden and key congressional committees that a credible whistleblower complaint shows FDA watered down troubling inspection findings in at least four instances at biologics plants in recent years, including at a Merck plant that now produces Johnson & Johnson vaccines.

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FDA on Thursday (April 1) gave Moderna the greenlight to use a new multi-dose vial for its COVID-19 vaccine that can contain up to 15 doses. The agency also let health care providers know they can now extract up to 11 doses from currently available vials, an increase from the 10-dose limit.

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Medicare payment advisors unanimously agreed to direct HHS to put together a smaller and more harmonized group of alternative payment models as a first step to improving those demonstrations and Chair Michael Chernew said the commission will continue looking at how to improve value-based care when it reconvenes in the fall.

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Medicare Payment Advisory Commission staff estimate CMS’ policy of basing Medicare laboratory pay rates on commercial-payer rates will save 24% on average once it is fully implemented, but they say the savings will vary based on the test type and warn independent labs’ overrepresentation in the data collection might skew rates to the lower end and affect patient access.

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