Medicare

America’s Health Insurance Plans defends prior authorization and tells CMS it is working with other stakeholders to streamline and improve the process -- though, unlike providers, the group doesn’t offer any suggestions for how CMS could help.

Senate Finance Chair Chuck Grassley said Friday (Aug. 16) that Senate staff are pre-negotiating with House Democrats on drug-pricing legislation that could pass the lower chamber in a bid to pressure Senate Majority Leader Mitch McConnell (R-KY) to hold a Senate vote.

CMS Administrator Seema Verma declined to say whether the Medicare International Pricing Index is a separate initiative from the so-called favored-nations executive order the president is writing to ensure the United States pays no more for drugs than other countries.

The Government Accountability Office verified both drug makers’ assertions that the amount of rebates they pay is rising much faster than drug net prices and pharmacy benefit managers’ assertion that they pass nearly all rebates to their insurer clients.

Analysts at McDermott Will & Emery say that some health care watchers believe prior authorization-like programs will become increasingly common in fee-for-service Medicare after CMS proposed adding prior authorization to certain hospital procedures in the proposed outpatient hospital rule for 2020, though stakeholders note those requirements are for a fairly small and specific set of circumstances.

John O’Brien, HHS’ top drug-pricing official, is stepping down after nine months and will be replaced by John Brooks, the principal deputy director of the Center for Medicare and formerly a White House Domestic Policy Council official, HHS announced Monday (Aug. 12). The departure comes after several of President Donald Trump’s marquee drug-pricing policies were blocked or pulled in recent months.

CMS put out a fact sheet to help providers make sure they are correctly billing for nursing home services -- and abiding by the so-called three-day stay requirement -- after the HHS Office of the Inspector General found CMS has not corrected problems that contributed to noncompliance.

CMS encouraged state Medicaid agencies on Thursday (Aug. 8) to alter state operational policies or state plans as needed to participate in a new model and allow emergency medical services (EMS) providers to administer on-scene treatment or transport a Medicaid beneficiary to a location other than a hospital and still receive Medicaid reimbursement.

An expected proposal from the Substance Abuse and Mental Health Services Administration to change 42 CFR Part 2 could be released this month, according to stakeholders who want to see the stringent privacy scheme aligned with Health Insurance Portability and Accountability Act (HIPAA).