Medicare

Medicaid and CHIP Payment and Access Commission staff will focus future Dual Eligible Special Needs Plans work on potentially limiting enrollment to full benefit duals and examining the pros and cons of requiring state review of D-SNP marketing materials, staff said at an April 8 meeting.

House Energy & Commerce Committee leaders from both parties are urging HHS Secretary Xavier Becerra to step up enforcement of hospital transparency requirements considering reports that some hospitals aren’t complying.

A handful of accountable care organizations joined dozens of health systems and others, led by America’s Physician Groups, in pushing CMS to reconsider its decision not to accept additional applications for two tracks of the Direct Contracting demo, saying those interested in the demo were ready to apply and the agency’s move is a “serious blow” to those organizations.

Brand drug makers are now open to ending some patent-gaming industry practices, including “product hopping” and possibly “patent thicketing,” and rebating Medicare for Part B drugs, according to a legislative agenda released by the Pharmaceutical Research and Manufacturers of America Tuesday (April 13).

CMS will give providers and payers more time to apply to be part of the second round of the Primary Care First demonstration, coming as the agency puts other demonstrations and applications on hold.

CMS proposes to increase skilled nursing facility’s pay a net 1.3%, or $444 million, in fiscal 2022, and to add two new quality reporting measures in fiscal year 2023: vaccination rates among health care personnel staff and health care acquired infections.

Hospitals are calculating whether it would be better for them to immediately repay their Medicare loans or have the payments taken out of their claims after CMS announced it’s beginning to recoup payments under the Medicare Accelerated and Advance Payment Program.

CMS plans to modify the inpatient psychiatric facilities’ quality reporting program by adding a measure that assesses COVID-19 vaccination rates among health care personnel and another that expands who can provide follow-up care for patients hospitalized with a mental illness, according to a proposed rule unveiled Wednesday (April 7) that would also increase next year’s pay for the facilities.

The American Medical Association joined dozens of specialty physician groups and patient advocates on Wednesday (April 7) in asking CMS to delay its decision to require prior authorization for two service areas under the calendar year 2021 Medicare hospital outpatient prospective payment rule and to put off any future prior authorization policies until more data are collected.