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Medicare

February 01, 2019 | Daily News

CMS Administrator Seema Verma called price transparency a “marketing opportunity” for hospitals as she continued to urge them to go beyond CMS’ requirements with their price transparency lists on Tuesday (Jan. 29).

February 01, 2019 | Daily News

While stakeholders are mostly supportive of CMS’ expansion of the Value-Based Insurance Design demonstration, some are raising concerns with what the agency has dubbed an “aggressive” timeline for applications.

January 31, 2019 | Daily News

HHS’ proposal to ban drug rebates, unless they’re shared directly with seniors at the pharmacy counter, would significantly lower out-of-pocket retail-drug spending for the minority of seniors on expensive drugs, but it would raise premiums for all Medicare beneficiaries.

January 31, 2019 | Daily News

As House Progressive Caucus Co-Chair Rep. Pramila Jayapal (D-WA) gathers co-sponsors for an upcoming Medicare for All bill, which she says will be different than Sen. Bernie Sanders’ (I-VT) single-payer bill, Democrats signal they are open to a variety of approaches when it comes to single-payer or Medicare expansion.

January 31, 2019 | Daily News

The Trump administration’s proposal to let exchange plans prohibit some manufacturer drug coupons from counting towards patients’ out-of-pocket cost caps is praised by insurers and generic drug makers as a way to lower consumers’ costs and promote generics, but patient advocates and brand-drug companies say it would increase patients’ costs.

January 30, 2019 | Daily News

CMS wants Part D plans to expand access to naloxone, the opioid overdose reversal drug, through reduced cost-sharing and increased co-prescribing, and the agency is encouraging Medicare Advantage plans to offer pain management options like acupuncture and massage as supplemental benefits that the agency says can be opioid alternatives.

January 30, 2019 | Daily News

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.

January 30, 2019 | Daily News

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.

January 30, 2019 | Daily News

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.

January 30, 2019 | Daily News

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.

January 30, 2019 | Daily News

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.

January 30, 2019 | Daily News

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).

January 29, 2019 | Daily News

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.

January 29, 2019 | Daily News

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.

January 29, 2019 | Daily News

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.

January 29, 2019 | Daily News

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.

January 29, 2019 | Daily News

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).

January 28, 2019 | Daily News

The American College of Emergency Physicians is joining the effort to craft legislation that would mitigate so-called surprise billing and is pushing insurers to make more of an effort to cover emergency services and to take responsibility for payments.

January 28, 2019 | Daily News

Lobbyists say a BioCentury report Friday (Jan. 25) that the board of the Pharmaceutical Research and Manufacturers of America is considering a cap on drug price increases is correct, but a brand drug lobbyist said it is difficult to determine whether the board will vote to commit its members to such a pledge.

January 25, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley (R-IA) is pushing CMS to explain how it is making sure the agency isn’t overpaying for lab tests under the new lab pay system after a Government Accountability Office report said CMS could be paying billions more than necessary for tests -- a claim that the American Clinical Laboratory Association alleges doesn’t reflect reality.

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