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Medicare

May 31, 2019 | Daily News

The House Energy & Commerce Committee’s draft proposal to curb surprise billing has spurred sharp divisions between hospitals and insurers as did the Senate’s first stab at legislation several months ago.

May 31, 2019 | Daily News

Avalere says about half of providers in the voluntary Oncology Care Model could end up owing CMS money if they join a two-sided risk model with less downside than CMS’ initial offering -- the initial two-sided risk option included in the OCM could lead more than 70% of participants to owe money, according to Avalere’s analysis.

May 30, 2019 | Daily News

The Health Innovation Alliance (HIA) is calling on the Office of the National Coordinator for Health IT (ONC) to “go back to the drawing board” and rework its proposed interoperability rule, saying that proposed exceptions to information blocking prohibitions are too broad and the definitions of electronic health information (EHI) and health information networks (HINs) go beyond the intent of Congress and the agency’s regulatory authority.

May 29, 2019 | Daily News

CMS says the systems issue that caused Medicare Advantage and Part D premiums not to be automatically deducted from beneficiaries’ Social Security payments has been fixed and beneficiaries should be provided a grace period to repay those missed premiums, but one beneficiary advocate has been told that some individuals have already lost coverage because of missing payments and the agency needs to make sure beneficiaries are held harmless.

May 29, 2019 | Daily News

If HHS waits until November to ban Medicare drug rebates, consistent with the department’s regulatory agenda, it would be too late to implement the new policy in 2020, sources say.

May 28, 2019 | Daily News

CMS on Tuesday (May 28) finalized long-awaited updates to the Programs of All-Inclusive Care for the Elderly, including a reduction in PACE organization audits, a tweaked compliance oversight program and a decision to let some non-physician primary care providers be part of interdisciplinary teams.

May 28, 2019 | Daily News

A group of more than 30 House lawmakers, most of whom are Republicans and who are led by Rep. Michael Burgess (R-TX), asked CMS earlier this month to consider using the innovation center to run a demonstration expanding the use of physician-owned hospitals.

May 24, 2019 | Daily News

HHS’ Office of Civil Rights (OCR) on Friday (May 24) proposed to replace the Obama-era rule on the ACA’s non-discrimination section 1557 with a significantly altered rule that rolls back protections for transgender individuals and woman who have had an abortion, repeals several language access requirements, and narrows the scope of the provision.

May 24, 2019 | Daily News

A draft legislative package released by Senate health committee leaders Thursday (May 23) would require plans to have up-to-date provider directories, available online or within 24 hours of an inquiry, but Medicare Advantage (MA) plans would not be included in that policy, according to the office of Chair Lamar Alexander (R-TN).

May 23, 2019 | Daily News

In a quick turn of events, the focus of drug-pricing legislation in the House shifted from Medicare negotiation to Part D reinsurance reform, which also is the approach that is being considered in the Senate.

May 22, 2019 | Daily News

CMS Administrator Seema Verma on Wednesday (May 22) said the agency is taking its time with a national Medicare coverage policy for new expensive hospital-administered cancer drugs, which was due to be published May 17 but was delayed, because the policy will affect coverage of drugs other than the two chimeric antigen receptor (CAR) T-cell therapies already on the market.

May 22, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley said Wednesday (May 17) that committee members are considering a rework of financial liability in the catastrophic phase of Medicare Part D to help curb rising drug prices.

May 22, 2019 | Daily News

After legislative talks between House Speaker Nancy Pelosi (D-CA) and President Donald Trump ground to a halt Wednesday morning, Senate Finance Chair Chuck Grassley (R-IA), who is helping lead negotiations on health care policy, said the Senate was always in the driver’s seat in the drug-pricing debate.

May 22, 2019 | Daily News

Lawmakers stuck to partisan lines as they debated the tradeoffs of a single-payer health care system during a House Budget Committee hearing, with Republicans focusing on how a transition to the system could disrupt American health policy and Democrats highlighting the potential positive outcomes.

May 22, 2019 | Daily News

President Donald Trump said Wednesday (May 22) that legislative negotiations on drug pricing are on hold until Democrats stop investigations into his potential role in his campaign’s ties to Russia and into other actions he has taken while in office.

May 22, 2019 | Daily News

Milena Sullivan with Avalere expects a mandatory radiation oncology bundle that HHS signaled was in the works last year to be included in a proposed rule under review at the White House Office of Management and Budget, and others following the rule also said they wouldn’t be surprised to see the model included.

May 22, 2019 | Daily News

The Center for Medicare and Medicaid Innovation (CMMI) pushed back by a week the deadline for stakeholders to respond to a request for information (RFI) on one payment option that is part of a new voluntary primary care model, though the reason for the delay has not been made clear.

May 22, 2019 | Daily News

The Trump administration’s spring regulatory agenda, released Wednesday (May 22), shows that two of HHS’ most disruptive drug-pricing regulatory actions -- its proposal to base Medicare Part B pay rates on foreign drug prices and its overhaul of the rebate system -- are set to be released later than originally anticipated.

May 21, 2019 | Daily News

Rep. Peter Welch (D-VT) said he has been pushing Senate Finance Chair Chuck Grassley to embrace a Medicare drug price negotiation scheme that includes a formulary designed to make it easier for patients and their doctors to bypass coverage restrictions.

May 21, 2019 | Daily News

HHS will not publish a rule banning drug rebates before bids from Medicare Part D plans and Medicaid managed care plans are due June 3, according to a memo CMS sent insurers Monday (May 20).

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