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November 12, 2020 | Daily News

Medicare Advantage plans’ dialysis payments need to be revamped to reduce costs in a market that’s increasingly dominated by two companies, Medicare Payment Advisory Commission members said Tuesday (Nov. 10).

November 11, 2020 | Daily News

A coalition of health care groups has kicked off a campaign aimed at getting Congress and regulators to put doctors and patients in control of treatment decisions by rolling back utilization management tools widely used by insurers and pharmacy benefit managers.

November 10, 2020 | Daily News

FDA advisers on Friday (Nov. 6) butted heads with agency staff over Biogen’s Alzheimer’s drug candidate, which if approved would likely spark a debate over the price of the first drug for a tragic condition that is expensive to care for.

November 09, 2020 | Daily News

When the Supreme Court hears the challenge to the Affordable Care Act on Tuesday (Nov. 10), prescription drug policies are at stake in addition to the future of the insurance exchanges.

November 03, 2020 | Daily News

House Ways & Means Chair Richard Neal (D-MA) and Energy & Commerce Chair Frank Pallone (D-NJ) are pressing CMS to scrap its proposal to loosen restrictions on physician-owned hospitals as laid out in the proposed hospital outpatient pay rule, saying the proposal goes against the restrictions lawmakers purposely put in place.

November 02, 2020 | Daily News

CMS on Monday (Nov. 2) finalized new Medicare add-on payments for innovative dialysis equipment that can be used in the home as part of its 2021 end-stage renal disease pay rule and expects to raise pay for free-standing ESRD facilities by 2%.

November 02, 2020 | Daily News

Both President Donald Trump and Democratic nominee Joe Biden want to allow Americans to save money by importing prescription drugs from Canada, but such a policy might not matter in a Biden administration if Congress passed a policy allowing Medicare to negotiate cheaper drug prices, drug policy experts say.

October 30, 2020 | Daily News

CMS is asking for feedback on a proposal to add coronavirus vaccination rates to performance measures that determine whether Medicare Advantage and Part D plans receive bonuses because the agency believes health plans will play a crucial role in encouraging seniors to get the vaccine.

October 28, 2020 | Daily News

Coronavirus vaccines will be free to all Medicare beneficiaries because Medicare will cover, in entirety, the up to $2.6 billion cost of paying doctors to administer coronavirus vaccines, and doctors will bill traditional Medicare for all beneficiaries so private Medicare Advantage plans do not need to cover the cost, CMS Administrator Seema Verma said Wednesday (Oct. 28).

October 28, 2020 | Daily News

CMS’ fourth COVID-19 interim final rule doubles down on the agency’s push for price transparency from providers, threatening penalties if they don’t make the cash price of COVID-19 diagnostics publicly available, and also extends the fifth year of the hip-and-knee bundles demonstration for six more months.

October 28, 2020 | Daily News

Lawmakers face a host of health policy areas to deal with after the election -- starting with funding the government and health extenders during the lame duck session, followed by COVID-19 stimulus legislation, drug pricing, surprise billing and potentially a fix to the Affordable Care Act in the next Congress, lobbyists say. Other areas that might come into play include easing pay cuts some providers are set to see in 2021 under the physician fee schedule, expanding telehealth and, if Democrats win big on Nov. 3, moving toward a public option.

October 27, 2020 | Daily News

CMS on Tuesday (Oct. 27) proposed a 2021 durable medical equipment pay rule that would permanently hike pay for rural areas, expand coverage of continuous glucose monitors, codify procedures for determining pay for new DME and expand coverage of external infusion pumps for certain drugs.

October 27, 2020 | Daily News

CMS on Tuesday (Oct. 27) announced it is only awarding competitive bidding contracts to durable medical equipment suppliers for off-the-shelf back and knee braces, but the agency claims it is not formally delaying the 2021 competitive bidding program for other DME categories and simply left them out for now because their inclusion wouldn’t save enough money.

October 27, 2020 | Daily News

About 40% of hospitals have not fully reported their COVID-19 data, CMS revealed Monday when it began allowing people to see which hospitals are reporting all required data every day.

October 23, 2020 | Daily News

Administration officials are expected to say within days how they plan to make coronavirus vaccines free for everyone, HHS Deputy Chief of Staff for Policy Paul Mango said Friday (Oct. 23).

October 23, 2020 | Daily News

House lawmakers from both parties continue their push to make some telehealth waivers permanent after the COVID-19 public health emergency, although a co-chair of the Congressional Telehealth Caucus warns a bill likely won’t hit the floor until after the election.

October 21, 2020 | Daily News

CMS Administrator Seema Verma announced on Wednesday (Oct. 21) that, after listening to stakeholder feedback, the agency will delay the mandatory radiation oncology demonstration until July, giving providers an extra six months before the model goes into effect.

October 19, 2020 | Daily News

The American Hospital Association says providers are considering asking the Supreme Court to take up their cases against the Part B reimbursement cuts for 340B drugs and Medicare pay cuts for outpatient clinic visits at certain off-campus hospital facilities after the full U.S. Court of Appeals for the District of Columbia Circuit declined to rehear those cases.

October 19, 2020 | Daily News

A lobbying group called Infusion Providers Alliance has formed to oppose international reference pricing for drugs, specialty pharmacy mandates and a measure in the Senate Finance Committee’s drug pricing bill that would lower reimbursement at physician practices that generate a significant part of their revenue from administering drugs.

October 16, 2020 | Daily News

Center for Medicare and Medicaid Innovation Director Brad Smith said the ongoing bundled pay demo was on track to lose more than $2 billion prior to mid-model changes that some have worried could cause providers to drop out of the demonstration.