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Inside CMS - 03/23/2017

  • Conservatives: HHS 'Phase 2' May Lead To Litigation, Instability

    Vocal members of the Freedom Caucus said after a Friday (March 17) meeting with HHS Secretary Tom Price and CMS Administrator Seema Verma that the promised administrative "phase 2" of the Republican health overhaul doesn't assuage their opposition to the American Health Care Act. They fear that uncertain HHS changes on top of a bill they view as weak will cause further problems for health care.

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  • Updated GOP Bill Inflates Caps For Aged On Medicaid, Repeals Taxes Now

    GOP chairs of key House committees unveiled a much-anticipated managers amendment that revises their health reform legislation in a bid to get the votes needed to pass the bill, which is slated for a floor vote Thursday.

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  • Trump Focuses CMS' Budget On High Priority Medicare, Medicaid Functions

    President Donald Trump's "skinny budget" for fiscal 2018 pumps more money into efforts to stem Medicare and Medicaid waste, fraud and abuse, but also signals possible changes to Medicare, Medicaid and the Children's Health Insurance Program by saying agency resources should be focused on the "highest priority activities" necessary to keep the programs running efficiently.

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  • Collins: NY Side Deal Will Not Lead To Similar Deals To Get GOP Votes

    Rep. Chris Collins (R-NY) said the deal given to New York Republicans to garner their votes for the American Health Care Act will not lead to the back-room deals that Republicans often complained about during the Obamacare wheeling and dealing that resulted in the so-called cornhusker kickback, which didn't make it into the law, the bay state boondoggle and Louisiana purchase.

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  • S&P: States May Lose Medicaid Managed Care Plans Under AHCA

    States will need to lean on private Medicaid insurers under the per-capita caps proposed in the GOP's American Health Care Act, but the plans may lose money under the new financing model and have to walk away from their Medicaid contracts with states, Standard & Poor's ratings analysts say.

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  • Doctors Still Waiting On MIPS Eligibility Notifications From CMS

    CMS says it is aiming to get doctors information on whether they meet the volume thresholds for participating in the Merit-based Incentive Payment System this spring, and the Medical Group Management Association says the lack of eligibility notifications is “generating considerable frustration and confusion.”

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  • GOP Bill Cuts Medicaid Beyond ACA Repeal

    Republicans' plan to repeal and replace the Affordable Care Act would go much further for Medicaid than a mere reversal of ACA policies, former Congressional Budget Office Director Douglas Elmendorf said Thursday (March 16). After the CBO estimated greater-than-expected coverage losses, Republicans added funds that aimed at increasing tax credits to help certain groups buy private exchange coverage, but most of the estimated coverage losses were in Medicaid, and the updated bill adds both measures that could both boost and cut Medicaid enrollment.

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  • Nursing Homes, Community Health Centers Criticize AHCA

    Some national provider groups, including those most affected by Medicaid cuts, have yet to oppose Republicans' American Health Care Act, despite the Congressional Budget Office's estimates of major Medicaid coverage losses and despite many prominent doctor and hospital trade organizations coming out against the bill. Among those still on the fence are trade groups representing community health centers and nursing homes.

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  • Meadows, Paul: Freedom Caucus Has Enough Votes To Block AHCA

    House Freedom Caucus Chair Mark Meadows (R-NC) said there are enough conservatives in the House and Senate to block the American Health Care Act, a day before the bill is slated to hit the House floor.

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  • Massie: GOP Leadership Jeopardizes Lawmakers' Seats By Pushing AHCA

    As Republican leadership whips votes for the American Health Care Act, due on the House floor on Thursday (March 23), members of the conservative Freedom and Liberty Caucuses say they still count 40 lawmakers who continue to oppose the bill. One Liberty Caucus member, Rep. Thomas Massie (R-KY) said that since the bill seems doomed in the Senate, lawmakers may be jeopardizing their seats in 2018 for no reason if they vote for it.

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  • AHCA Changes Draw More Support, Freedom Caucus Still A Hurdle

    After a managers amendment and a visit from President Donald Trump and HHS Secretary Tom Price, some moderate Republicans have decided to support the American Health Care Act. But House Freedom Caucus Chair Mark Meadows, who Trump specifically called out during a Republican conference meeting Tuesday (March 21), said there are still enough people in his conservative bloc to prevent the bill's passage on Thursday.

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  • Industry, Analysts Wary Of Changes To GOP Bill's Medicaid Policies

    Industry leaders and policy experts say the various carrots GOP leadership is offering conservatives and moderates through the changes to the American Health Care Bill -- including a provision that mandates New York state change its Medicaid financing structure and one that bans states that have not already expanded Medicaid from doing so -- will cause more disruption to Medicaid markets than would the original bill.

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  • Snyder Urges Michigan Lawmakers To Rethink Medicaid Cuts In AHCA

    Michigan Gov. Rick Snyder (R) on Tuesday urged lawmakers in his state to raise concerns about the American Health Care Act's effects on Medicaid. He sent members of his state’s congressional delegation individual letters Tuesday (March 21) that break down the number of each lawmaker’s constituents who rely on traditional Medicaid and Medicaid expansion, and he even separated out the number of children and the blind and disabled.

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  • McConnell Says Senate Will Take Up AHCA Next Week

    Senate Majority Leader Mitch McConnell (R-KY) said he expects the American Health Care Act will be taken up next week in the upper chamber.

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  • GOP Would Need One Fewer Vote On Thursday To Pass AHCA

    Rep. Louise Slaughter (D-NY) is out sick, according to her spokesperson, and if she can't make the vote on the American Health Care Act Thursday (March 23) Republicans would need one less lawmaker to vote for the GOP health bill to secure its passage. Normally, a House lawmaker missing a vote would not matter, but Republicans are counting every head for what is expected to be a tight vote.

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  • Price, Verma Brief House GOP On Administrative Changes To Medicaid

    CMS Administrator Seema Verma accompanied HHS Secretary Tom Price to a meeting with Republican lawmakers Friday morning (March 17) to explain changes the administration plans to make to Medicaid without the help of Congress.

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  • Four GOP Governors Push Medicaid Reform Plan

    Four GOP governors whose states expanded Medicaid said the health bill heading to a House vote would cripple state Medicaid programs and urged Republicans to stabilize private insurance before broaching Medicaid -- while floating their own reform plan that lets states choose Medicaid per-capita caps, block grants or the current financing structure, and gives states new flexibility to set program requirements and to control drug costs by not having to cover all FDA-approved drugs.

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  • Trump Doubles Down On Call For Drug Negotiation

    President Donald Trump again called for bidding to bring down drug prices at a rally in Nashville, TN Wednesday evening -- coming a week after the White House appeared to signal its drug price-reduction strategy was instead focused on reforming FDA's generic drug approval policies.

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  • CMS Delays Start Of Cardiac Bundles, Joint-Replacement Bundle Expansion

    CMS is pushing back the start date of its mandatory cardiac care bundles at least three months to give the new administration time to review the rule that sets them up and, if necessary, change the policy behind those bundles, the agency said Monday (March 20). Although the newly issued interim final rule pushes back the start date of the cardiac care models -- as well as changes to the Comprehensive Care for Joint Replacement model -- from July to October, the agency says it believes a six-month delay is warranted and solicits public comment on pushing the start date of bundles in the rule back to January 2018.

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  • Lilly Discloses List- & Net-Price Hikes, But Patient Advocate Unimpressed

    Eli Lilly disclosed list- and net-price increases as part of a new transparency initiative aimed at countering criticism of drug price increases, but Patients for Affordable Drugs co-founder David Mitchell said the initiative is a public relations move that does nothing to fix the core problem of rising drug prices.

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  • HRSA Again Delays 340B Ceiling Price Rule, Points To Ongoing Questions

    The Health Resources and Services Administration again pushed back implementing the 340B ceiling price and civil monetary penalty rule, saying there are still substantial questions about the rule and signaling the administration may be taking a broader overall look at the implementation of 340B drug discounts and how this rule fits in.

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  • Energy & Commerce Touts Avalere Report On AHCA Stabilization Fund

    House Energy & Commerce Republicans on Friday (March 17) touted a new Avalere report on the American Health Care Act's patient and state stability fund for 2018, which found states with the fewest insurers in the exchange markets would likely see the most money under the current methodology, as would large states like California and New York.

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  • AHCA Passes Budget Committee Despite 3 Republicans Voting No

    The American Health Care Act passed the House Budget Committee without amendments 19-17 with GOP Reps. Mark Sanford (SC), Dave Brat (MI) and Gary Palmer (AL) voting against the measure.

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  • Employers See Opening For Further Caddy Tax Delay, Full Repeal

    Employer stakeholders, while pleased the GOP health bill would delay implementation of the 40 percent tax on high-cost health plans through 2024, remain hopeful lawmakers will fully repeal the so-called Cadillac tax or at least delay it an additional two-years in the final version of the bill.

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  • House Rules To Mark Up Medical Malpractice Bill Week Of March 27

    The House Rules Committee is tentatively scheduled to mark up legislation to cap medical malpractice noneconomic damages at $250,000 next week.

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  • Bill Proposes Risk-Based FDA Regulation Of LDTs, New Center & User Fees

    Recent calls from the medical device industry for Congress to push a risk-based framework for regulating laboratory developed tests (LDTs) appear to be answered by a new bipartisan draft bill that would give FDA authority over design, development, validation and production of in-vitro clinical tests (IVCTs), including LDTs, while retaining CMS' jurisdiction over laboratory operations. The program would also grandfather in already marketed IVCTs, give FDA recall authority over certain tests, and set up new center at FDA for regulating the tests, coupled with a user fee program.

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  • Former FDA Chiefs Take On Drug Imports; Gottlieb Raised Similar Concerns

    Four former FDA commissioners on Thursday (March 16) urged Congress not to move forward with drug importation, which has been eyed by both President Donald Trump and members of Congress as a drug pricing solution, on the grounds that allowing drug imports would pose safety risks, strain FDA resources and do little to bring down costs. Trump's pick to head FDA also previously said the amount of agency oversight needed to prevent entry of fake drugs would zero out any cost-savings from imports.

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  • GOP Forgot To Repeal Medicaid EHBs In AHCA But Is Fixing The Oversight

    Republicans inadvertently didn't eliminate essential health benefits for the beneficiaries covered by Medicaid expansion in their updated version of the American Health Care Act, which they released Monday (March 20), but Energy & Commerce Chair Greg Walden has an amendment to add the repeal back in, a Republican Energy & Commerce spokesperson said.

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