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Medicare

August 19, 2019 | Daily News

CMS Administrator Seema Verma on Thursday (Aug. 15) said there are some areas of Medicare that scream for more utilization oversight -- and thus prior authorization -- but she also said prior authorization shouldn’t interfere with the practice of medicine or delay patient care, both issues about which providers have long complained.

August 19, 2019 | Daily News

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.

August 19, 2019 | Daily News

Providers are urging CMS to curb or streamline the use of prior authorization by Medicare Advantage plans, particularly through increased electronic prior authorization procedures, in response to the agency’s latest request for advice on how to cut back on administrative burdens.

August 17, 2019 | Daily News

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.

August 16, 2019 | Daily News

White House budget officials and the Pharmaceutical Research and Manufacturers of America are scheduled to meet Aug. 26 to discuss the Trump administration’s plan to tie U.S. drug prices to those in foreign countries, according to the Office of Management and Budget website.

August 16, 2019 | Daily News

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.

August 14, 2019 | Daily News

Seniors’ out-of-pocket maximum in Medicare Part D is set to increase 25% in 2020, and lawmakers have shown no indication that they will address the problem before the end of 2019.

August 14, 2019 | Daily News

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.

August 13, 2019 | Daily News

Democratic presidential candidate and South Bend, Indiana Mayor Pete Buttigieg unveiled a rural health plan that closely mirrors that of other Democratic presidential candidates, including Sen. Elizabeth Warren’s proposals on reimbursement, telehealth and workforce disparities, and Sen. Michael Bennet’s call for CMS to adopt new payment policies to tackle social determinants of health.

August 13, 2019 | Daily News

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.

August 13, 2019 | Daily News

Democratic presidential candidate Sen. Kirsten Gillibrand (NY) released a rural health plan Wednesday (Aug. 7) that calls for expanding long-term services and supports (LTSS), but otherwise echoes the calls of other Democratic presidential candidates for more Medicare and Medicaid reimbursement and telehealth services as candidates increasingly focus on rural health in their presidential bids.

August 12, 2019 | Daily News

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.

August 12, 2019 | Daily News

CMS cancelled the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration due to low participation rates, and some physicians may have opted not to participate partly because there was no ability to access bonuses from the Merit-based Incentive Payment System or the alternative pay models, according to the American Medical Group Association (AMGA).

August 09, 2019 | Daily News

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.

August 09, 2019 | Daily News

The House Energy & Commerce Committee wants CMS Administrator Seema Verma to testify this fall as part of the committee’s oversight of Medicare and Medicaid, a committee source told Inside Health Policy.

August 09, 2019 | Daily News

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.

August 08, 2019 | Daily News

CMS is asking what chronic conditions should be eligible for Chronic Condition Special Needs Plans before the agency convenes a panel this fall to update the list so it complies with changes in the Bipartisan Budget Act of 2018.

August 08, 2019 | Daily News

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).

August 07, 2019 | Daily News

Hospitals that administer the expensive new CAR-T gene therapy are not required to participate in a clinical registry or study aimed at determining whether real-world results mirror those from clinical trials used to get the cancer drugs approved, according to the national coverage determination CMS published Wednesday (Aug. 7).

August 07, 2019 | Daily News

HHS recently withdrew rules proposed decades ago that would have codified the HHS Office of Inspector General’s ability to penalize hospitals that offer doctors incentives to reduce care for Medicare and Medicaid beneficiaries and would have expanded an existing safe harbor to include waivers of beneficiary cost sharing for those with certain Medigap plans.

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