Medicare

The year-end spending package passed by the Senate Thursday (Dec. 19) includes provisions pushed by laboratories that would delay commercial pay data reporting until 2021 and require Congress’ Medicare payment advisers to study how CMS has implemented an earlier law aimed at basing Medicare pay rates for lab tests on commercial rates.

Congress included the pro-generic CREATES Act to help pay for five months of so-called Medicare and Medicaid “extenders” in the one-year government funding bill, plus a few minor biologics policies.

The end-of-year spending deal released Monday (Dec. 16) includes funding for five months for several Medicare and Medicaid extenders, as well as two years of Medicaid funding for the territories and an even longer extension for the Patient-Centered Outcomes Research Trust Fund, as previously anticipated.

A federal district court judge on Monday (Dec. 16) turned down hospitals’ request to keep CMS from putting the second year of so-called site-neutral cuts for clinics at certain off-campus hospitals in place next year, as she said the court doesn’t have jurisdiction over the 2020 rule at this time.

The government on Thursday (Dec. 12) appealed a federal district court’s ruling that CMS lacked authority to impose deep reimbursement cuts for clinic visits at certain off-campus facilities.

Despite its plan to follow a federal court decision and repay hospitals for deep cuts to clinic visits at certain off-campus hospital facilities for 2019, CMS tells Inside Health Policy it will implement the second year of those so-called site-neutral pay cuts to the same providers in 2020.

Federal lawmakers from California grilled the American Kidney Fund over its decision to stop providing premium assistance to about 3,700 patients with end-stage renal disease, but AKF says it made it clear the charity could not operate under a recently enacted California bill and believes the state is looking for someone to blame now that about 3,700 patients will lose premium assistance.

The House Rules Committee on Tuesday (Dec. 10) cleared House Speaker Nancy Pelosi’s drug pricing bill (H.R. 3) for a floor vote after Pelosi reached a deal with progressives to increase the minimum number of drugs subject to negotiation each year to 50 and to restore Rep. Pramila Jayapal’s (D-WA) amendment to extend price-spike protections to private plans.

The Congressional Progressive Caucus expressed optimism it would get at least one of its amendments added to House Speaker Nancy Pelosi’s drug pricing bill, following a meeting between caucus leaders and the California Democrat Tuesday afternoon (Dec.10).