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Medicare

Wednesday, 23 August 2017

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.

Tuesday, 22 August 2017

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.

Tuesday, 22 August 2017

Republican health reform efforts may have stalled but Democrats are moving forward on a number of proposals that aim to build on the existing infrastructure in a move toward universal coverage and Independent Sen. Bernie Sanders (VT) will soon introduce legislation that would expand Medicare to all Americans.

Monday, 21 August 2017

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.

Friday, 18 August 2017

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.

Friday, 18 August 2017

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.

Wednesday, 16 August 2017

The federal appeals court for DC said a lower court needs to look closer at HHS' claim that it would be impossible for the agency to lawfully reduce the Medicare appeals backlog at the Administrative Law Judge level by 2021, though the court said the burden should fall on HHS to prove that is so once the case goes back to the district court.

Tuesday, 15 August 2017

CMS proposed on Tuesday (Aug. 15) to cut the number of geographic areas participating in the innovation center's mandatory Comprehensive Care for Joint Replacement demonstration by almost half, make the model voluntary for providers in the remaining areas, and to cancel the Episode Payment Models and Cardiac Rehabilitation incentive payment models.

Tuesday, 15 August 2017

The Medical Group Management Association is calling for a national effort to relieve the regulatory burden on physicians, and a vast majority of the physician practices that responded to MGMA's 2017 regulatory burden survey -- 82 percent -- rated Medicare's new physician payment system as very or extremely burdensome, and many were worried about the clinical relevance of the program.

Monday, 14 August 2017

The White House Office of Management and Budget is reviewing a rule from CMS that would cancel a mandatory bundled payments program for cardiac care and changes to joint replacements bundles.

Monday, 14 August 2017

Long-term care hospitals seem to be closing or reorganizing ahead of Medicare pay cuts that take effect soon, according to industry sources and filings and news reports of those closings.

Thursday, 10 August 2017

CMS certified Inovalon and Avalere, a subsidiary of Inovalon, as a member of the Qualified Entity Program, also known as the Medicare Data Sharing for Performance Measurement Program, with the capacity to examine patient-level claims from all 50 states and DC, the company announced on Tuesday (Aug. 8).

Wednesday, 09 August 2017

House Ways & Means health subcommittee Chair Pat Tiberi (R-OH) said he plans to schedule roundtables in September to discuss ideas for cutting regulations on health care providers, then introduce legislation to cut red tape this fall.

Wednesday, 09 August 2017

Democratic senators are pushing back against a Trump administration proposal to remove provisions from an Obama-CMS rule that bans long-term care facilities from using pre-dispute arbitration agreements, and both beneficiary advocates and the nursing home lobby say Trump's CMS may have overstepped its authority with the proposed rule.

Tuesday, 08 August 2017

CMS Deputy Administrator for Innovation and Quality Patrick Conway is leaving the agency to serve as the CEO of Blue Cross Blue Shield of North Carolina, CMS and the insurer announced on Tuesday (Aug. 8).

Monday, 07 August 2017

HHS Office of Inspector General recently announced its first review of Medicare payments for telehealth services and checking up on providers who bill Medicare for that care.

Friday, 04 August 2017

Aetna is ratcheting back its business in Affordable Care Act-compliant small group plans and instead is pushing self-insured small group plans that are not ACA-compliant or subject to the law’s regulations.

Friday, 04 August 2017

Senate Finance Committee members Mark Warner (D-VA) and Johnny Isakson (R-GA) introduced legislation on Thursday (Aug. 3) to create a temporary reimbursement structure for Medicare home infusion services, known as the Medicare Home Infusion Therapy Access Act of 2017.

Friday, 04 August 2017

A federal district court will allow a lawsuit calling for a right for beneficiaries to appeal placement under observation during a hospitalization to proceed as a class action suit, and the Center for Medicare Advocacy and Justice in Aging project hundreds of thousands of beneficiaries are likely to be members of such a class.

Thursday, 03 August 2017

New Jersey lawmakers are pleased CMS extended the imputed rural floor policy that establishes a minimum wage index for hospitals in three all-urban states through fiscal 2018, and while CMS warns that the policy was only meant to be temporary, Rep. Bill Pascrell (D-NJ) and Sen. Cory Booker (D-NJ) are pushing for a permanent solution.

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