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Medicare

September 18, 2019 | Daily News

House Speaker Nancy Pelosi (D-CA) will release a bill Thursday (Sept. 19) that directs Medicare to negotiate prices for at least 25 drugs, and up to 250 drugs, according to lawmakers who have been briefed on the bill.

September 18, 2019 | Daily News

Traditional Medicare remains the driver of risk-based pay models, according to a report released by Premier Inc. Tuesday (Sept. 17), but a Premier official said progress is slower than the hospital group had hoped for as few providers surveyed expect their total patient percentage in these models to exceed 50% within five years.

September 17, 2019 | Daily News

A federal judge on Tuesday (Sept. 17) said CMS lacked authority to impose deep reimbursement cuts for clinic visits at certain off-campus facilities.

September 17, 2019 | Daily News

House Speaker Nancy Pelosi (D-CA) is expected to release her long-awaited government drug price negotiation plan on Wednesday (Sept. 18).

September 17, 2019 | Daily News

Providers and patient advocates are calling on lawmakers to back a bill limiting prior authorization in Medicare Advantage, but the insurance lobby is pressing policymakers not to impose any statutory restrictions on the process.

September 17, 2019 | Daily News

Mental health and substance use treatment advocates are calling on Congress to reauthorize funding for mental health clinics, remove barriers to medication-assisted treatment and allow mental health counselors to bill Medicare.

September 13, 2019 | Daily News

Plans say prior authorization for medication-assisted treatment (MAT) for individuals with substance use disorders helps the treatment be used safely and effectively, but providers are worried that prior authorization is a barrier to treatment in the middle of an opioid crisis.

September 13, 2019 | Daily News

Justice in Aging and the National Consumer Voice for Quality Long-Term Care are urging others to “speak out for nursing home residents” by opposing CMS’ proposed rule to ease nursing home regulations, and the groups have developed sample comments that lay out why the agency shouldn’t move forward with many of the rule’s proposals.

September 12, 2019 | Daily News

CMS Administrator Seema Verma told hospitals on Tuesday (Sept. 10) that the agency will have to tackle the high costs of hospital care in order to drive down total health care costs, even though she previously told reporters the agency was not planning to target hospital spending.

September 12, 2019 | Daily News

Lawmakers and administration officials are slowly backing away from the White House’s promise to roll out a large-scale Affordable Care Act replacement plan and are instead saying the president is focusing on smaller-scale items such as drug pricing and surprise billing, and will take another look at protecting coverage for preexisting conditions if the courts overturn the health law.

September 12, 2019 | Daily News

The National Association of Accountable Care Organizations (NAACOS) called on CMS to pay close attention to what it sees as a dip in the number of new ACO participants for 2019 and lays out recommendations that could help entice new organizations to join the program.

September 12, 2019 | Daily News

Health care issues made up a large portion of the first two Democratic debates as candidates parried over their respective visions on universal health coverage, and some Democratic strategists say the candidates in tonight’s debate need to also make clear that the Trump administration has been working to undermine the existing law, both through regulatory moves and by backing a lawsuit that aims to scrap the Affordable Care Act.

September 11, 2019 | Daily News

The Center for American Progress is pushing a number of policy options to help struggling rural hospitals stay open, some of which echo policy platforms from Democratic presidential hopefuls, and the left-leaning group is also imploring the Trump administration to stop allowing states to waive non-emergency medical transportation benefits in Medicaid.

September 10, 2019 |

The White House on Tuesday welcomed House Speaker Nancy Pelosi’s ideas on drug pricing, hiking President Donald Trump’s pressure on Senate Republicans and the drug industry to back a less aggressive, but strongly pharma-opposed, drug-pricing bill passed by the Senate Finance Committee.

September 10, 2019 | Daily News

The White House on Tuesday welcomed House Speaker Nancy Pelosi’s ideas on drug pricing, hiking President Donald Trump’s pressure on Senate Republicans and the drug industry to back a less aggressive, but strongly pharma-opposed, drug-pricing bill passed by the Senate Finance Committee.

September 10, 2019 | Daily News

A drop-off in Medicaid enrollment was the primary driver of the nation’s uninsured rate climbing to 8.5% in 2018 -- the first year since 2009 that the rate increased, according to national census data released Tuesday (Sept. 10).

September 09, 2019 | Daily News

A draft of House Speaker Nancy Pelosi’s Medicare price negotiation bill circulating among lobbyists calls for using international prices as an upper limit for what Americans pay for drugs and imposing harsh penalties to keep drug makers at the negotiating table, instead of relying on a third-party arbitrator as a backstop to negotiation.

September 09, 2019 | Daily News

Congressional Medicare advisers are considering recommending a unified, value-based incentive program for all post-acute care settings that would score providers on three quality measures and use a 5% withhold from base payments to fund the incentive payments.

September 06, 2019 | Daily News

Congress’ Medicare advisors discussed whether CMS should seek authority from Congress to expand its durable medical equipment competitive bidding program -- potentially even beyond DME -- because the commission views the program as a success.

September 05, 2019 | Daily News

CMS on Thursday (Sept. 5) finalized a sweeping program-integrity rule -- first proposed under the Obama administration -- that gives the agency greater latitude to block health care providers from participating in Medicare, Medicaid or the Children’s Health Insurance Program if they are affiliated with entities who are deemed to pose a heightened risk of fraud, waste or abuse.

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