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Medicare

December 03, 2020 | Daily News

CMS on Thursday (Dec. 3) released the third part of its direct contracting demonstration, known as the Geographic Direct Contracting Model, or Geo, but the full-risk demo, which will require participants to take on risk for beneficiaries in an entire geographic region, won’t get started until well into President-elect Joe Biden’s term in 2022 under the agency’s timeline.

December 03, 2020 | Daily News

The most-favored-nation demonstration, which aims to lower drug prices, undermines price-competing biosimilars by subjecting them to international reference pricing, according to Coherus BioSciences, the maker of the biosimilar covered by the demonstration.

December 02, 2020 | Daily News

CMS will phase out its list of inpatient-only procedures over three years and will allow Ambulatory Surgical Centers to perform more procedures, under a final 2021 hospital outpatient pay rule out Wednesday (Dec. 2) that also updates how the agency will calculate hospitals’ star ratings.

December 02, 2020 | Daily News

CMS backed away from its proposal to increase cuts to Part B pay for 340B drugs by an additional 6% in 2021, citing the COVID-19 public health emergency, and instead finalized its alternative proposal to continue paying hospitals for those drugs at the Average Sales Price minus 22.5% as part of the final 2021 hospital outpatient pay rule.

December 01, 2020 | Daily News

Specialty physicians blasted pay cuts finalized by CMS Tuesday (Dec. 1) and said they will ask Congress to reverse them, but CMS Administrator Seema Verma told Inside Health Policy the cuts are nothing out of the ordinary and should not be conflated with the current pandemic.

November 30, 2020 | Daily News

Rep. Ami Bera’s (D-CA) office hopes to get a two-year policy holding providers harmless from 2021 Medicare cuts that are linked to evaluation and management services pay wrapped into a year-end package.

November 24, 2020 | Daily News

CMS has pushed back the deadline for providers to update their pay information and claim 2018 alternative pay model bonuses to Dec. 13, after providers asked the agency to get rid of the earlier Nov. 13 deadline or at least push it out to the end of the year.

November 24, 2020 | Daily News

The Federation of American Hospitals is urging President-elect Joe Biden and his transition team to institute a national COVID-19 mitigation and communications strategy as opposed to the current, splintered state-based approach; to gradually ease the end of COVID-19 waivers, rather than cutting them off at the end of the public health emergency; and to work with Congress to increase access to telehealth post-pandemic.

November 20, 2020 | Daily News

HHS on Friday (Nov. 20) finished physician self-referral, or Stark, and anti-kickback reforms that have been in the works for much of the administration’s tenure, and key stakeholders immediately praised the final rules for protecting value-based care.

November 20, 2020 | Daily News

CMS on Friday (Nov. 20) finalized changes to Organ Procurement Organizations’ Medicare and Medicaid Conditions for Coverage, moving away from self-reported measures and setting up a 12-month review period during the organization’s four-year recertification cycle.

November 20, 2020 | Daily News

Trump administration officials announced Friday (Nov. 20) a pilot that, starting Jan. 1, mandates seven years of deep Medicare pay cuts to doctors nationwide and that is projected to make fewer drugs available to seniors.

November 20, 2020 | Daily News

CMS plans to expand the non-emergency ambulance prior authorization demonstration across the country once the pandemic ends. In the meantime, the agency will continue the demonstration in states where it is already underway.

November 19, 2020 | Daily News

The White House budget office on Wednesday (Nov. 18) finished its reviews of physician self-referral, or Stark, and anti-kickback reform rules -- both of which are part of HHS’ so-called regulatory sprint and have been in the works for much of the Trump administration’s tenure.

November 19, 2020 | Daily News

The incoming Biden administration is likely to rely on administrative actions for much of its health policy agenda but there is also a possibility some bipartisan bills could move forward, health policy experts from both parties said during recent post-election events.

November 18, 2020 | Daily News

It took three business days for White House budget officials to review the final version of a drug-rebate-ban rule that HHS and White House officials said they withdrew in the summer of 2019.

November 18, 2020 | Daily News

If the Trump administration uses an interim final rule to put in place the president’s plan to base Medicare reimbursement on international drug prices, drug makers will surely sue, drug lobbyists say.

November 17, 2020 | Daily News

When the president revived an effort to ban drug rebates, most lobbyists assumed HHS would have to restart rulemaking since the department had withdrawn a rebate-ban proposed rule last year, but HHS is ignoring that withdrawal, and a former adviser to the Trump White House said the proposed rule was not officially terminated.

November 16, 2020 | Daily News

Regulatory work by the Trump HHS is continuing full speed in the aftermath of the election, with the surprise reappearance of a once-scrapped rule to ban Medicare drug rebates, finalization of the Medicaid managed care rule and the White House budget office’s recent clearance of FDA guidance and a Substance Abuse and Mental Health Services regulation.

November 12, 2020 | Daily News

Hospitals are hearing from CMS that the agency will not update its overall hospital star ratings in January as earlier planned in order to buy time to review public comments and finalize proposed changes to the star ratings calculations laid out in the proposed 2021 hospital outpatient pay rule.

November 12, 2020 | Daily News

The Medical Group Management Association wants CMS to get rid of -- or at the very least push back -- a deadline for providers to claim their 2018 alternative pay model bonuses.

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