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January 10, 2019 | Daily News

House Ways & Means leaders from both parties worry CMS is unilaterally using demonstrations to revamp Medicare law, and call on the agency to be open about how they create demonstrations that test new approaches to paying for goods and services.

January 10, 2019 | Daily News

Newly tapped Senate Finance Chair Chuck Grassley (R-IA) said Wednesday (Jan. 9) he opposes Medicare drug price negotiation, but he seemed to imply he’s open to either changing or eliminating the risk corridors that help protect Part D drug plans from losing money.

January 10, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley (R-IA) said he is waiting to see what CMS formally proposes before passing judgment on the International Pricing Index demonstration, but he nevertheless opposes the most important aspect of the informal proposal: indexing U.S. drug prices to those set by foreign countries.

January 10, 2019 | Daily News

CMS Administrator Seema Verma said Thursday (Jan. 10) that an updated 2018 requirement that hospitals post price information online in a machine-readable format is just a ‘first step’ to helping patients understand health costs, and that hospitals themselves can go further with price transparency.

January 09, 2019 | Daily News

Senate Finance Committee Chair Chuck Grassley (R-IA) on Wednesday (Jan. 9) said he expects to spend time looking at Medicare and Medicaid waste, fraud and abuse now that he has resumed the chairmanship, along with health care anti-trust issues.

January 09, 2019 | Daily News

CMS says in recently released guidance that states do not need to obtain a Medicare denial for certain durable medical equipment coverage before Medicaid, which acts as a secondary payer for those dually eligible for Medicare and Medicaid, can pay for the equipment.

January 08, 2019 | Daily News

House Budget Committee Chairman John Yarmuth (D-KY) asked the Congressional Budget Office to study the design and policy implications of developing a single-payer health care system.

January 07, 2019 | Daily News

HHS recently told stakeholders it will prioritize models out of the Physician-Focused Payment Model Technical Advisory Committee that reduce mortality or are expected to reduce spending by at least $10 billion annually once expanded nationally, and the department has pegged six model areas for close consideration.

January 07, 2019 | Daily News

House Democrats say they haven't yet determined whether to push for Medicare price negotiation of all drugs or just the expensive ones.

January 04, 2019 | Daily News

Cancer doctors were already working on a performance-based pay system with drug makers when HHS proposed indexing Part B drug prices to those in foreign countries, and the proposed International Pricing Index model lit a fire under those negotiations.

January 03, 2019 | Daily News

New Republicans joined the Senate health, Finance and Aging committees for the 116th Congress, Senate Majority Leader Mitch McConnell (R-KY) announced on Thursday (Jan. 3).

January 03, 2019 | Daily News

Newly-elected House Speaker Nancy Pelosi (D-CA) has paved the way for hearings on Medicare for All early in the upcoming Congress, ushering in the Democratic Congress by appealing to the more left-leaning, progressive members of her caucus.

January 03, 2019 | Daily News

Medicare beneficiaries start 2019 with a new Medicare Advantage open enrollment period, lobbyists and stakeholders continue to pore over the administration’s revamp of the Accountable Care Organization program unveiled late in December and others are waiting on interoperability and electronic health records rules that at the start the new year are still under White House Review.

January 03, 2019 | Daily News

The Trump administration is expected to keep drug pricing on center stage in 2019 following a flurry of action last year. In 2018, the administration released a 44-page blueprint with ideas and questions on potential ways to lower drug prices and reduce out-of-pocket costs, and HHS, FDA and CMS proposed a torrent of regulations and notices.

January 03, 2019 | Daily News

The generic drug lobby sees expanding the use of international reference pricing as a potential opportunity to remedy low reimbursement rates for generic drugs, Association for Accessible Medicines President Chip Davis told Inside Health Policy.

January 02, 2019 | Daily News

It’s going to be more difficult for brand drug makers to get Congress to lower their share of seniors’ Part D donut-hole costs now that Democrats control the House, and the industry also exposed itself to billions of dollars in offsets while trying to roll back the donut hole policy in 2018, which Congress could use in 2019 to fund other health sector priorities.

December 31, 2018 | Daily News

The American Association for Homecare says that durable medical equipment suppliers that want to re-enter former competitively bid markets may be interested in becoming non-participating Medicare suppliers so that they can charge beneficiaries more than the Medicare allowed amount, given that CMS left many of the DME rates relatively low during the gap before the next round of competitive bidding starts.

December 28, 2018 | Daily News

CMS is increasing laboratory fees under the Clinical Laboratory Improvement Amendments by 20 percent, the agency said Friday (Dec. 28). The fee increase is the first in 20 years and is necessary for the program to be sustainable through 2021, CMS said.

December 21, 2018 | Daily News

CMS on Friday (Dec. 21) finalized its overhaul of the Medicare Shared Savings Program by shortening the amount of time that accountable care organizations can participate in an upside-only model and reducing the shared-savings rate for ACOs that are not taking on financial risk.

December 20, 2018 | Daily News

CMS on Thursday (Dec. 20) released proposed changes to the Medicare Advantage risk-adjustment model that will take into account each beneficiary’s total number of conditions, as required by the 21st Century Cures Act.