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Medicare

January 10, 2020 | Daily News

CMS says the revamped Medicare Shared Savings Program Accountable Care Organizations are on track to save $2.9 billion over 10 years, as the agency’s actuary projected when the regulatory overhaul was finalized, but the National Association of ACOs raises concerns about the program’s lack of growth because it says fewer new ACOs are joining the program than in past years.

January 10, 2020 | Daily News

CMS’ evaluation of the Next Generation Accountable Care Organization’s second year shows that Medicare spending increased slightly during 2017, though the National Association of ACOs said those results are likely due in part to the way the evaluation compared their performance to others.

January 10, 2020 | Daily News

The Supreme Court agreed Friday (Jan. 10) to hear a case that could revive an Arkansas law regulating pharmacy benefit managers, a move with widespread implications for state efforts to lower drug prices through limits on PBMs’ activities and profits.

January 10, 2020 | Daily News

CMS suggested as part of new guidance laying out ways to avoid duplicate discounts between 340B and Medicaid that states could use state plan amendments to keep some -- or all -- providers and contract pharmacies from using 340B drugs for Medicaid beneficiaries, and 340B hospitals quickly pushed back.

January 09, 2020 | Daily News

CMS hasn’t been able to pay more than 2,800 providers in alternative payment models their 5% bonus for 2017 performance because it doesn’t have their banking information, the agency says, and it has given those clinicians until Feb. 28 to clear that up so the bonuses can be paid.

January 08, 2020 | Daily News

The House Energy & Commerce health subcommittee considered three bills Wednesday (Jan. 8) that would strengthen patient protections for Medicare and Medicaid, and the hearing has given beneficiary advocates hope that these protections will be included in legislative packages passed this year.

January 08, 2020 | Daily News

More than half of voters consider out-of-pocket costs for prescription drugs and other aspects of health care as top concerns ahead of the first primaries, according to a recent poll from Morning Consult and Bipartisan Policy Center.

January 08, 2020 | Daily News

In 2020, the people who play the largest role in shaping health care policy may not be members of Congress, officials at CMS, or even presidential candidates -- they may be federal judges.

January 08, 2020 | Daily News

CMS on Monday (Jan. 6) touted that about 98% of providers in the Merit-based Incentive Payment System received a bonus or avoided a pay cut for the program’s second performance year, 2018, but some stakeholders say that a budget-neutral system where everyone does well doesn’t provide the necessary incentives to move providers to value-based pay and the program is becoming more of a compliance exercise than motivation for providers to move away from fee-for-service.

January 07, 2020 | Daily News

In light of President Donald Trump’s Medicare executive order, CMS is seeking advice on how to eliminate Medicare regulations that are more stringent than state laws and limit what services certain non-physician practitioners can offer.

January 07, 2020 | Daily News

Beneficiary advocates say a Wednesday House Energy & Commerce health subcommittee hearing may signal that beneficiary protection bills could be included in legislative packages passed this year.

January 07, 2020 | Daily News

Many stakeholders are looking more to the Trump administration than to Capitol Hill for new Medicare policies in the lead up to the 2020 election, particularly as they wait for final Stark, anti-kickback, and interoperability rules as well as any rules that come out of the Medicare executive order signed by President Donald Trump last year.

January 06, 2020 | Daily News

CMS on Monday (Jan. 6) proposed for 2021 to speed up the transition to a new Medicare Advantage risk-adjustment model and to increase its reliance on encounter data in the first part of the so-called advance notice and call letter for MA and Part D.

January 06, 2020 | Daily News

The former CEO of Anthem’s Diversified Business Group will lead the Center of Medicare and Medicaid Innovation, CMS announced Monday (Jan. 6), replacing former Adam Boehler who stepped down as director last year.

January 03, 2020 | Daily News

Beneficiary advocates are pleased that House Speaker Nancy Pelosi’s (D-CA) drug pricing bill passed the lower chamber with a number of Medicare improvements, including protections aimed at expanding the number of beneficiaries who can access a Medigap plan. Even though Pelosi’s bill is expected to stall in the Senate, some following the issue say the package’s inclusion of the Medigap policies has spurred dialogue on the issue and the policies could be on the table for future health care legislation.

January 02, 2020 | Daily News

The industry-lauded repeal of the health insurance tax may lead to Medicare Advantage plans offering more supplemental benefits tied to investment in social determinants of health, according to industry advocacy organizations.

January 02, 2020 | Daily News

Beneficiary advocates are calling on HHS, Congress and the administration to adopt policies to bridge racial disparities in health care, as proposed in a recent report by the Medicare Advantage advocacy organization Better Medicare Alliance in collaboration with other advocates.

December 30, 2019 | Daily News

The nursing home industry says an expected recommendation from Congress’ Medicare advisors for fiscal 2021 would hurt long-term and post-acute care providers, as the recommendation would come amid other CMS Medicaid proposals about which the industry is also concerned.

December 30, 2019 | Daily News

When Inbrija was close to market, Acorda Therapeutics wanted to set the price of Parkinson’s therapy below the specialty tier monthly threshold of $670, but consultants and pharmacy benefit managers made the company set the list price at $950 per box, according to Ron Cohen, who founded Acorda and is the president and CEO of the company.

December 23, 2019 | Daily News

Medicare Advantage plans pushed back against a new HHS Office of Inspector General report that concluded the plans might be receiving inappropriate risk-adjusted payments, saying the report relies on old data and overstates the improper pay rate.

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