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Inside CMS - 08/24/2017

  • Canceling Mandatory Demos Would Have Small Impact On Doc-Pay System

    CMS' proposal to cancel mandatory bundling demonstrations would have a small impact on the new Medicare physician pay system, provider lobbyists say, because although that system aims to get doctors to join alternative pay models, the pay models CMS wants to cancel are designed for hospitals.

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  • CMS Officials May Use RFI To Change Direction Of Innovation Center

    CMS officials have been working on a Request For Information on the direction of the Center for Medicare and Medicaid Innovation, according to sources familiar with the RFI.

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  • Voluntary Participation Expected To Expand Among Large Hospitals

    Despite proposing to downsize the mandatory Comprehensive Care for Joint Replacement demonstration and cancel the Episode Payment Models and Cardiac Rehabilitation models without proposing replacements, experts do not believe CMS will be able to roll back bundled payments as an alternative payment model, and they expect the agency to move toward voluntary bundles created with more input from physicians and hospitals. Large hospitals are also expected to continue implementing voluntary bundling.

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  • HRSA Proposes Another Delay Of 340B Ceiling Prices, Penalties

    The Health Resources and Services Administration proposed another delay, this time until July 2018, of a rule on the 340B drug discount program that sets ceiling prices and civil monetary penalties as the agency considers changing the regulation. Some drug makers want the agency to revamp the rule but 340B hospitals want HRSA to implement it.

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  • Grassley Says $465 M EpiPen Settlement Likely Shortchanges Taxpayers

    The Department of Justice announced Thursday (Oct. 17) an EpiPen settlement of $465 million, which is the same amount DOJ denied having settled on last October when EpiPen maker Mylan announced the deal. Senate Judiciary Chair Charles Grassley (R-IA) said it appears the settlement "shortchanges" taxpayers.

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  • Beneficiaries Concerned Nursing Home Guidance Could Lower Penalties

    Nursing homes welcomed guidance released last month changing how penalties are levied against nursing homes, but beneficiary advocates expressed concern that the guidance is a way to weaken nursing home oversight and will make the penalties less frequent and less costly.

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  • Patient Group Seeks 'Fair' Price For First-Of-Its-Kind Cancer Therapy

    In anticipation of what could be the most expensive cancer drug to date, the Patients for Affordable Drugs launched Thursday (Aug. 17) a national campaign demanding that Novartis factor in the considerable taxpayer investment in early research of the company's CAR-T cell therapy, which is at the forefront of individually tailored medicines that could cure certain cancers.

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  • DME Suppliers Expect Bills Offering Relief From Multiple Pay Cuts

    Durable medical equipment suppliers say legislation to provide "long-term relief" from Medicare pay cuts for suppliers in rural and non-competitive bid areas as well as address fee schedule cuts for stationary oxygen and allow an exemption from competitive bidding for accessories for manual complex rehabilitation technology could be introduced when lawmakers return from August recess. The American Association for Homecare is encouraging members in its weekly email updates to use the congressional recess to drum up support for the expected legislation.

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  • Insurance Commissioners Push Regulatory Changes To Stabilize Market

    State insurance commissioners are pushing the Trump administration to embrace a slew of recommendations they say would help stabilize the health insurance market, improve choice and affordability for consumers, and affirm states' regulatory authority, in response to CMS' request for stakeholders' suggestions. Most of the commissioners' proposals focus on amending or repealing rules seen as encroaching upon states' traditional role in regulating their insurance markets, as well as loosening barriers to state flexibility.

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  • Govs. Kasich, Hickenlooper Writing Bipartisan Health Care Proposal

    The vocal bipartisan gubernatorial duo -- John Kasich (R-OH) and John Hickenlooper (D-CO) -- said they will soon release their own health care proposal in a joint interview on Colorado Public Radio Monday (Aug. 21). The governors' key ideas as they discussed them on Colorado Matters included instituting a reinsurance mechanism, funding the Affordable Care Act's cost-sharing reduction payments and raising the employee minimum for small businesses required to buy group coverage, with Medicaid reforms left for a future discussion.

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  • Doctor-Patient Rights Project Reignites Issuer, Drug Maker Feud

    The insurance industry is hitting back at a new campaign that aims to make a point that medical management techniques, like step therapy and prior authorization, impair consumer access to medication.

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  • State Officials To Testify At Senate Hearings On Market Stabilization

    State insurance commissioners will testify before the Senate health committee on Sept. 6 and governors will follow up on Sept. 7 as Committee Chair Lamar Alexander (R-TN) and Ranking Democrat Patty Murray (WA) lead the effort on a stabilization package for the individual markets in 2018. Alexander reiterated his previous statements that he wants a package in place by Sept. 27.

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  • Navigators Faced With Consumers Who Think Congress Eliminated Coverage

    States and navigators face extra challenges in promoting their exchanges as they head into open enrollment: They don't know what kind of federal support and outreach to expect; the enrollment period has been cut in half (an abbreviation that wasn't supposed to take effect until next year); and Congress' tumultuous attempts to overturn the Affordable Care Act has confused the general public, leading some enrollees to believe the law and its coverage no longer exist.

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  • Covered CA Delays Setting Rates; Approves Stabilization Package

    The largest state-based exchange said Thursday (Aug. 17) that it will delay setting 2018 premium increases until Sept. 30 due to ongoing federal uncertainty, including the potential that Congress will fund the ACA's cost-sharing reductions. Covered California's Board of Directors also approved several policies to help stabilize the market, including additional outreach funding and new contract language that allows issuers to recoup unexpected losses caused by federal policy changes.

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  • Two Co-Ops Fail To Become For-Profit Entities In 2018

    Two of the remaining health insurance co-ops created under the Affordable Care Act failed to complete a transition into for-profit entities for the 2018 plan year -- and are both now in receivership -- but there is still hope that they may be able to offer products in future years. Minuteman Health, which sold plans in New Hampshire and Massachusetts, announced Wednesday (Aug. 16) that its new entity, Minuteman Insurance Company, had secured neither the funding nor the needed state licensing in time to participate. Maryland's co-op Evergreen Health had been on track to transition to a new entity until late July when its investors pulled out after getting new financial information, according to the Baltimore Sun. Maryland's insurance commissioner tells Inside Health Policy that other investors have made inquiries about purchasing the issuer out of receivership.

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  • Rule Loosening ACA Contraceptive Mandate Expected Out Soon

    Womens groups and other advocates groups are bracing for HHS to release an “interim final rule” that, if identical to a draft version leaked in May, would make it easier for employers to opt out of the Affordable Care Act's requirement to provide cost-free coverage of FDA-approved contraceptives.

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  • Public Interest Groups Defend Standing In Suit Over Trump's '2-1' Rule Order

    Public interest groups are fighting the Department of Justice's novel claim that showing harm to the groups' ability to comment on regulatory repeals is not enough to give them standing to sue over President Donald Trump's executive order (EO) directing agencies to identify two rules to repeal for every new rule they issue, countering that DOJ's argument would limit citizens' ability to challenge a host of constitutional violations.

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  • Thirty States Draft More Than 60 Drug-Price Transparency Bills

    Thirty states have drafted more than 60 drug price transparency bills aimed at identifying drug maker expenses and unveiling business practices of pharmacy benefit managers, according to an analysis by the National Academy for State Health Policy.

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  • Anthem, Harvard Pilgrim To Stay in New Hampshire; Minuteman Out For 2018

    New Hampshire's insurance department announced Wednesday (Aug. 16) -- the deadline for federally facilitated exchange issuers to submit all QHP data except rate filings to regulators -- that Anthem and Harvard Pilgrim will stay in the state's exchange market in the face of market instability exacerbated by ongoing uncertainty from the federal government. The insurance department also said that it is allowing plans to revise their rates to assume that the cost-sharing reductions will not be reimbursed moving forward. CMS last week extended the rate filing deadline from Aug. 16 until Sep. 5 in order to provide time for plans to make adjustments.

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  • Stakeholders Eye REMS-Reform Bill As CHIP Offset; Brands Gird For A Fight

    Stakeholders are pushing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act as an offset for renewing CHIP funding, multiple industry stakeholders tell Inside Health Policy.

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  • Former CMS Heads: Medicaid, Marketplace Changes Should Be Separate

    Former CMS administrators Gail Wilensky and Andy Slavitt say lawmakers need to separate long-term Medicaid reforms from what they see as the most pressing task at hand -- stabilizing and improving the exchanges. In the Journal of the American Medical Association on Aug. 15, Wilensky and Slavitt say lawmakers should take a year to gather bipartisan support for Medicaid reforms including reforming the waiver process, focusing the program on outcomes and making states less reliant on supplemental Medicaid funding.

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