Medicare

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.

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.

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.

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.

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.

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.

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.

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.

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.