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Inside CMS - 07/19/2018

  • Verma Touts Planned E/M Changes As Good For Doctors, Oncologists Wary

    CMS Administrator Seema Verma sent a letter to doctors touting a proposed overhaul of evaluation and management documentation and coding, as well as changes to electronic health records, as reforms that will make doctors' lives easier, though oncologists argue the E/M coding proposal “defies all logic.”

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  • Drug Makers, Hospitals Clash On Potential Changes To 340B

    Drug makers are asking HHS to change the 340B drug discount program's patient definition and consider limits on contract pharmacies and off-campus sites, but hospitals are urging HHS not to narrow the patient definition and to remove or loosen the restrictions on 340B hospitals' participation in group purchasing organizations.

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  • CMS Proposes To Put DME Competitive Bidding On Hold And Make Changes

    Medical equipment suppliers won’t have to bid for Medicare business next year as CMS hasn’t yet started the next round of bidding and existing contracts run out at the end of the year, according to a proposed rule CMS released Wednesday (July 11), and one agency official said CMS needs time to implement changes to the bidding program laid out in the rule.

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  • CMS Overhauls Office Visit Pay In Proposed 2019 Physician Fee Rule

    CMS is proposing to overhaul how Medicare pays for office visits and how doctors document those visits in what Administrator Seema Verma said would be “one of the most significant reductions in provider burden ever taken by any administration.”

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  • HHS: Executive Order On ALJs Could Help With Appeals Backlog

    An HHS official told Inside Health Policy that President Donald Trump's executive order changing how administrative law judges are appointed means the HHS secretary will choose those judges, which could streamline the hiring process and potentially help with the appeals backlog at the Office of Medicare Hearings and Appeals.

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  • HHS Touts Proposed Doctor Pay Cuts As Drug-Price-Cutting Measure

    HHS officials touted CMS’ proposal to cut doctor pay for administering new biologics as a drug-price-cutting measure, but like other administration drug-price proposals it would hurt providers, not drug companies.

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  • Verma: Stark Law Changes Could Be Released By Year's End

    CMS Administrator Seema Verma is certain the agency will make changes to the physician self referral, or Stark, law, and on Thursday (July 12) said she hopes to release those changes by the end of the year.

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  • Gottlieb: FDA, CMS Eye Reimbursement Changes To Stem Drug Shortages

    FDA, through its Drug Shortages Task Force, will work with CMS to revamp reimbursement policies for critical access drugs, especially sterile injectables, to incentivize manufacturers to invest in and modernize their manufacturing processes and spur development of critical access drugs, FDA Commissioner Scott Gottlieb said during a policy summit on Tuesday (July 17).

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  • CMS Issues Guidance On RA, Other Programs In Light Of NM Court Ruling

    CMS Thursday released additional, largely technical, guidance to issuers in light of the New Mexico court's order to vacate the risk adjustment program, reiterating the 2017 payments and collections will be halted, but also noting the agency will still collect user fees from issuers for the plan year since they are not reliant on the budget-neutral methodology rejected by the court.

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  • AHIP Welcomes New Members

    America’s Health Insurance Plans on Monday (July 16) announced the addition of four new member organizations, Priority Health of Michigan, Health Plan of San Joaquin, CareOregon and CalOptima, which participates in Medicare Advantage and Medicaid in Orange County, CA.

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  • House Approps Approves 2019 HHS Funding Bill Banning New ACA Funds

    The House Appropriations Committee approved 30-22 a fiscal 2019 HHS funding bill, following a marathon 13-hour markup, that includes a provision blocking any new funding for the Affordable Care Act and prohibiting the use of funding for existing navigator programs.

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  • Dems Seek Answers On RA Suspension, Demand Interim Final Rule

    The ranking Democrats of the Senate and House committees of jurisdiction over health care on Monday (July 16) demanded the Trump administration immediately reverse its decision to halt the Affordable Care Act's risk adjustment program, and sought more information on the timing and justification for the decision, including whether the White House was involved.

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  • CA Court Dismisses CSR Case; States Can Refile if CMS Scraps Silver-Loading

    A federal court in California on Wednesday dismissed a case brought by 18 Democratic attorneys general challenging the Trump administration's decision last year to end the ACA's cost-sharing reduction payments to insurers, but the court leaves the door open for the attorneys general to refile their case if HHS moves to block the silver-loading workaround that has made up for the lack of CSRs.

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  • W&M Sends 11 Health Bills To Floor After Two-Day Contentious Markup

    The House Ways & Means Committee wrapped up a two-day, often fiery, health care markup on Thursday (July 12), ultimately sending to the floor 11 bills that collectively would change rules on tax-favored health savings accounts, offer retroactive relief from the ACA's employer mandate, delay the Cadillac tax until 2023 and allow consumers to use tax credits for off-exchange products.

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  • Both Brand Lobbies Oppose Several Proposals In HHS Drug-Price Blueprint

    The brand drug lobbies oppose several of the proposals in HHS’ so-called blueprint for lowering drug prices, including proposals to change Part D coverage rules, apply Part D negotiation techniques to Part B, revive the Part B Competitive Acquisition Program, eliminate the Medicaid rebate cap and disclose list prices in drug ads.

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