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Medicare

June 24, 2004 | Daily News

CMS' effort to require pre-approval of states' Medicaid budgets is waning as the agency now may require such pre-approval on a voluntary basis in only some states that are given incentives to participate, according to a state Medicaid source.

The pre-authorization proposal started as an emergency regulation in January with only 24-hour notice and raised an outcry from states. HHS quickly committed to both a period of consultation with states and a proposed rule with a regular comment period.

June 23, 2004 | Daily News

Some charity aid will be allowed to count towards the Medicare drug benefit's $3,600 limit on beneficiary out-of-pocket spending, although it is not clear whether contributions from foundations specifically targeted at covering high drug costs will be allowed to fill the benefit's gap in coverage, according to CMS officials.

June 21, 2004 | Daily News

The Senate Finance Committee is focusing its sights on drug makers who have admitted they are using a Medicaid pricing exemption for commercial purposes.

The committee is investigating whether Medicaid is being overcharged for drugs because pharmaceutical companies are violating congressional intent of the Medicaid nominal price exception, which was designed to maintain discount drug rates for charitable organizations.

June 18, 2004 | Daily News

Separate studies of three different state pharmacy assistance programs show they tend to enroll sicker-than-average beneficiaries, raising the prospect that the stand-alone Medicare drug plans will have to cover high drug expenditures by hiking premiums. Such a move could further skew enrollment towards seniors most in need of drug coverage because they have high drug costs

June 18, 2004 | Daily News

States and providers are charging that CMS is overstepping its statutory authority by pressuring states to end certain Medicaid funding mechanisms it previously approved, and should wait for new legislation or a formal rulemaking process before implementing the policy change.

Various sources have told Inside CMS that with the congressional calendar shortened by the presidential elections, it is highly doubtful that Medicaid financing enforcement legislation can get introduced and passed this year.

June 17, 2004 | Daily News

With budget bills proposing caps on Medicare and Medicaid spending expected to reach the House floor next week, providers are lining up against them and hoping the House leadership will not support them.

On Monday (June 14), a coalition named "America's Health Care Providers" sent a letter to all House members urging them to reject "any budget enforcement measure that contains Medicare and Medicaid spending limits or caps."

June 17, 2004 | Daily News

A leading stalwart of last year's $20 billion federal relief package for the states is blasting a General Accounting Office (GAO) report that suggests the money did not effectively stimulate the economy or relieve budget-weary states.

June 17, 2004 | Daily News

Mississippi consumer advocates and state lawmakers are battling to prevent 65,000 impoverished seniors and disabled people from losing their Medicaid coverage under a cost-cutting exercise Mississippi's governor says is needed to reduce the state's financial obligations under the new Medicare drug benefit.

June 16, 2004 | Daily News

The flagship proposal of the Bush administration's initiative to help more institutionalized disabled Medicaid beneficiaries live at home or in their communities has, after almost 18 months, found a legislative vehicle and is expected to be voted on in the House next week, but cuts to Medicaid to fund the bill have generated new controversy.

June 16, 2004 | Daily News

Medical professionals lobbying for expanded Medicare coverage of positron emission topography (PET) are welcoming CMS' decision to let Medicare pick up the bill for PET scans on certain beneficiaries with suspected Alzheimer's disease.

June 15, 2004 | Daily News

CMS Administrator Mark McClellan is looking to create an office of patient advocacy at CMS that could serve as a venue for patient advocacy groups to weigh in on coverage and other policy issues. The office may provide a forum for a dialogue on the controversial issue of how cost-effectiveness of expensive new treatments should be incorporated into Medicare policy, according to CMS Chief Medical Officer Sean Tunis.

June 15, 2004 | Daily News

Despite stiff resistance from Republican leaders, a House Appropriations subcommittee late Monday (June 14) voted to prevent FDA from spending any money in fiscal year 2005 to enforce the current ban on drug reimportation. The narrow bipartisan passage of Rep. Marcy Kaptur's (D-OH) amendment is likely to usher in renewed debate about the merits of reimporting prescription drugs and the high cost of brand-name pharmaceuticals.

June 11, 2004 | Daily News

The off-label use of thalidomide for treating a blood cancer may be covered by the upcoming Medicare part B interim prescription drug coverage program under a narrowly tailored exception to proposed criteria that exclude coverage for treatments not approved by FDA.

The chief medical officer for CMS, Sean Tunis, indicated today (June 11) that the agency may draft an exception policy that would cover thalidomide, which is widely used as an off-label, orally administered therapy for the blood cancer multiple myeloma.

June 11, 2004 | Daily News

CMS and the pharmacy benefit managers (PBMs) expected to provide the new Medicare prescription drug benefit are struggling to reach agreement on what drug-specific pricing information PBMs will give the agency.

PBMs are seeking to protect sensitive, proprietary data, such as manufacturer rebates on specific drugs, while the agency is pushing for cost data to use in developing formulas that will adjust plan payments based on the health status of beneficiaries and geographic variation in prices.

June 10, 2004 | Daily News

CMS may play a role in deciding which drugs should be covered by the new Medicare prescription drug plans in order to bring some national consistency to the program, a senior CMS official said. The move could spark opposition from the pharmaceutical industry, which says CMS has no legal right to dictate drug coverage under the new benefit.

June 10, 2004 | Daily News

CMS is facing pressure from both chain drug stores and their congressional allies to go beyond the legislative language for the Medicare drug benefit and impose stricter requirements for drug plans to pass on both manufacturer rebates and pharmacy discounts to Medicare beneficiaries and to set ground rules for competition between retail and in-house mail-order pharmacies.

June 09, 2004 | Daily News

One of the principal House architects of the Medicare prescription drug benefit is pushing CMS to ensure mentally ill, Medicaid-eligible beneficiaries are not forced to switch medications when they start coverage under a Medicare drug plan, as psychiatrists and advocates for the mentally ill are urging state Medicaid officials to join in lobbying CMS to ensure such continuity of care.

June 09, 2004 | Daily News

With the less than a month before CMS implements a newly revised rule establishing criteria for inpatient rehabilitation facilities (IRFs), lawmakers in both chambers are gathering support to again urge the agency for another delay in the so-called "75 percent rule" and to put on hold contractor policies that set new medical necessity criteria for rehab centers to receive payment.

June 08, 2004 | Daily News

A renewed call by Democrats for the Bush administration to automatically enroll low-income Medicare beneficiaries in the discount card program seems to be gaining traction at CMS. The call comes as proponents of the Medicare reform law are citing problems with the card program, which they acknowledge has had a rocky start.

June 08, 2004 | Daily News

Capitalizing on a General Accounting Office (GAO) ruling against Bush administration television commercials touting the Medicare drug benefit, New Jersey Democrats Rep. Frank Pallone and Sen. Frank Lautenberg have introduced emergency legislation that would require President Bush's re-election campaign to reimburse Medicare for about $43,000 spent on the video news releases. The GAO decided last month that the video news releases were illegal uses of government funds for covert propaganda.

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