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Daily News

January 30, 2019

Medicare Advantage plan revenue is expected to increase by about 1.6 percent in 2020 -- a smaller increase than plans received in 2019 -- though that does not take into account rising risk scores or changes to pay based on rebasing the county rates on which MA benchmarks are set, CMS said in a fact sheet on the draft Medicare Advantage and Part D rate notice and call letter.

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CMS proposed in a draft call letter Wednesday (Jan. 30) how Medicare Advantage (MA) plans could submit new supplemental benefits specifically for chronically ill enrollees in their 2020 bids.

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California’s state-based exchange reported Wednesday (Jan. 30) a nearly 24 percent drop in new consumers signing up for coverage, which the exchange attributes to the loss of the federal mandate to buy coverage, yet overall enrollment slipped only a half a percent largely due to strong re-enrollment numbers.

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Consumer advocacy group Families USA is out with an issue brief calling on lawmakers to consider enhancing and expanding financial assistance to improve exchange plan affordability rather than focusing on reinstating the Affordable Care Act’s reinsurance program, which was phased out after 2016.

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HHS Deputy Secretary Eric Hargan anticipates implementing physician self-referral, or Stark, law and anti-kickback statute reforms by the end of this year, and one CMS official said the agency has wide flexibility, within the confines of the current law, to make changes to the Stark regulation.

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Senate health committee leaders on Tuesday (Jan. 29) pushed for a five-year funding package for community health centers -- more than double the funding provided the last time lawmakers extended funding for those providers.

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House Energy & Commerce Democrats launched an investigation into rising insulin prices on Wednesday (Jan. 30), one day after two other committees highlighted the plight of diabetics who can’t afford new versions of the drug.

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An official in FDA’s medical device center announced the agency has launched a new project intended to encourage device stakeholders to partner with cybersecurity researchers -- also called white hat hackers -- as a means of boosting the resilience, transparency and trustworthiness of medical devices and the health care system overall.

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A think tank president says HHS’ proposal to index Medicare Part B drug prices to those in foreign countries references the wrong 15 countries, and his proposal for tweaking the administration’s proposal caught the attention of Freedom Caucus Chair Mark Meadows (R-NC).

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January 29, 2019

Sens. Bill Cassidy (R-LA) and Mark Warner (D-VA) are seeking comments on a draft bill to exempt performance-based drug-reimbursement contracts from the Medicaid best price rule, anti-kickback law and the so-called Stark law against doctor self-referrals, the senators announced Tuesday (Jan. 29).

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The Idaho Supreme Court considered Tuesday (Jan. 29) whether to declare Idaho’s Medicaid expansion plan unconstitutional less than three months after the state’s voters approved it in a ballot initiative, but several of the court’s justices expressed skepticism about arguments advanced by the group that is challenging the expansion.

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CMS Administrator Seema Verma on Tuesday (Jan. 29) previewed new demonstrations the agency is working on, including rural telehealth and multi-payer demonstrations, and she said the agency has spent the last year developing a way to increase provider participation in value-based care.

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An FDA official on Tuesday (Jan. 29) told a group of stakeholders that legacy medical devices remain an “intractable challenge” for promoting cybersecurity in the medical device space, a view also held by agency chief Scott Gottlieb who, on the same day, stated that one of FDA’s most critical challenges lies in addressing safety risks posed by the devices.

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Sen. Chuck Grassley (R-IA), the new Senate Finance Committee chairman, said that HHS Secretary Alex Azar is likely using the administration’s International Price Index model for Medicare Part B to extract concessions from pharmaceutical companies after the committee’s first in a series of planned hearings on prescription drug pricing.

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Democrats on the House Ways & Means Committee used Tuesday’s (Jan. 29) hearing on preexisting conditions to again highlight Republicans’ attempts to repeal the health law during the last Congress, whereas GOP members tried to pivot away from problems with the Affordable Care Act and steer to other health care issues.

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The parties appealing Texas U.S. District Judge Reed O’Connor’s ruling in the high-profile challenge to the Affordable Care Act now have until Feb. 8 to respond to House Democrats’ motion to intervene at the U.S. Court of Appeals for the Fifth Circuit.

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CMS Administrator Seema Verma says the agency is taking a closer look at medically necessary dental benefits for Medicare beneficiaries -- coming as beneficiary advocates say CMS already has authority to cover medically necessary oral health care and lawmakers on both sides of Capitol Hill are weighing changes to the statute to establish a Medicare oral health benefit including preventive care.

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The Center for Medicare & Medicaid Innovation (CMMI) said the expanded 2020 Value-Based Insurance Design model announced Jan. 18 will include new opportunities for plans to reduce beneficiary cost-sharing and add supplemental benefits based on chronic conditions and socioeconomic status.

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The Senate Finance Committee kicks off its first hearing on prescription drug pricing Tuesday (Jan. 29), but Sen. John Cornyn (R-TX) already tweeted that a future topic of investigation will be abuses of the rebate system by pharmacy benefit managers -- an announcement that would typically be made by committee chairman Sen. Chuck Grassley (R-IA).

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January 28, 2019

After Medicaid expansion made dramatic inroads in several red states in 2018, early signs from the opening days of this year’s state legislative sessions suggest that expansion may be on the horizon in even more red states in 2019.

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