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Medicare

January 20, 2004 | Daily News

The Renal Physicians Association (RPA) is urging CMS to delay implementation of a new policy that bases payment for treatment of end stage renal disease (ESRD) patients on the number of face-to-face visits with health practitioners.

January 16, 2004 | Daily News

AARP today (Jan. 16) called on pharmaceutical manufacturers to limit prices increases on their drugs to the rate of inflation as part of the group's multi-faceted plan to curb the escalating cost of prescription medicines. The political health care heavyweight also plans to push for approval of drug importation from Canada as well as authority for the HHS secretary to negotiate lower drug prices should private plans under the pending Medicare drug benefit fail to deliver expected drug discounts.

January 16, 2004 | Daily News

The Medicare reform law generally boosts hospital outpatient reimbursements for drugs that no longer qualify for bonus payments due new therapies, averting cuts opposed by drug makers, but, because of a quirk in the law, payments for some new drugs will be slashed 10 percent.

Because of the interaction between separate provisions in the mammoth law, the agency is cutting pass-through payments for some drugs from 95 percent of the average wholesale price (AWP) to 85 percent of the AWP listed by the manufacturer on a specified date.

January 15, 2004 | Daily News

The Medicare reform law gives hospitals payment incentives to use brand-name drugs instead of their generic competitors in the outpatient setting, but CMS is holding off on implementing the provision until a classification system can be finalized.

January 14, 2004 | Daily News

Just weeks after CMS' former chief drew heat for talking to prospective employers while negotiating Medicare's new drug law, the White House has cracked down on the granting of ethics waivers allowing high-level administration officials to job hunt while in office.

January 12, 2004 | Daily News

Sarah Walter, former lead health care advisor for Sen. John Breaux (D-LA), is the latest of a growing list of congressional Medicare staffers to leave Capitol Hill for the private sector.

January 12, 2004 | Daily News

Pilot programs are the latest scheme to get the administration to allow prescription drug reimportation, and the newest twist would use an Indian reservation in Maine to import the drugs -- a move that an industry expert believes makes an eventual pilot program more likely. Illinois also has asked HHS to allow it to do a pilot project, and several other states are considering various ways to buy drugs from Canada, though some states such as Florida and Oklahoma are trying to stop Internet drug sites from importing foreign drugs.

January 09, 2004 | Daily News

Senate Democrats are likely to embrace a broad drug reimportation plan pushed by Senate Minority Leader Tom Daschle (D-SD) over a narrower proposal by Sen. Edward Kennedy (D-MA) as they put together a legislative plan later this month to fix what they view as flaws in the new Medicare law, a congressional source says. The Senate Democratic caucus is concerned that the recently enacted Medicare reforms do little to lower escalating U.S. drug prices.

January 08, 2004 | Daily News

The new Medicare reform law has upped the workload of Congress' investigative arm and its Medicare advisory panel, tasking both entities with a number of studies to be completed over the next four years.

The General Accounting Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) are each called upon to undertake an array of studies for Congress, ranging from a probe into the adequacy of Medicare's physician payments to the drug utilization of low-income beneficiaries.

January 08, 2004 | Daily News

The Federal Trade Commission has issued a notice reminding brand-name and generic drug manufacturers that they must notify FTC and the Department of Justice (DOJ) of certain agreements signed on or after Jan. 7 that affect the sale or marketing of generic drugs. The newly enacted Medicare drug benefit imposed the new requirement, which is intended to quash anti-competitive agreements.

January 07, 2004 | Daily News

After Medicare conferees rejected an effort to expand federal medical coverage to certain legal immigrants, supporters of the legislation are positioning for yet another attempt at passage this year.

January 07, 2004 | Daily News

Cardio-thoracic surgeons took a step forward in their longstanding effort to boost reimbursement for clinical staff assistants, securing language in the Medicare bill calling for the Medicare Payment Advisory Commission (MedPAC) to study if practice expenses of cardio-thoracic surgeons "adequately take into account the attendant costs of nurse assistants at surgery." The report, due by Jan. 1, 2005, is supposed to include recommendations for legislative or administrative action.

January 06, 2004 | Daily News

The new Medicare reform law double bills the program for care provided by teaching hospitals to enrollees in Medicare HMOs under a new payment system for HMOs that reflects add-on payments for indirect medical education (IME). But it remains unclear whether HMOs or teaching hospitals are the beneficiaries of the wrinkle in the legislation.

January 06, 2004 | Daily News

The new Medicare reform law gives emergency room physicians greater assurance they will be reimbursed for care that they provide in order to comply with statutory obligations to assess and stabilize patients seeking emergency room treatment.

January 05, 2004 | Daily News

Drug producers and patient advocates have begun lobbying CMS to cover specific cancer and multiple sclerosis drugs under a two-year demonstration program that must come under a $500 million budget cap.

The Medicare reform law mandates the program under Section 641, but does not specify which drugs or treatments will be covered, although cancer and multiple sclerosis are targeted for coverage until the full drug benefit takes effect in 2006. CMS has to implement the demonstration within 90 days of the law's Dec. 8, 2003, enactment.

January 02, 2004 | Daily News

Hundreds of rural hospitals made eligible for higher Medicare reimbursements for outpatient services by the recent Medicare reform law will not be able to receive the payment boost for much of 2004 because of the way the bill was written.

December 31, 2003 | Daily News

The recent Medicare law's reform of drug reimbursement, regional physician rates, and physician updates will add $1 billion to Medicare's 2004 outlays, according to a CMS rule released today (Dec. 31).

December 30, 2003 | Daily News

Two of the Senate's swing votes on the Medicare bill have asked the General Accounting Office (GAO) to keep tabs on pharmaceutical drug prices so as to monitor the effect of price hikes on the purchasing power of the new discount card and on the cost of the future drug benefit.

December 30, 2003 | Daily News

In the wake of landmark passage of a Medicare prescription drug benefit, AARP is now turning its attention to holding down drug costs, earmarking reimportation and evidence-based drug selection as key mechanisms it plans to work on this year.

December 22, 2003 | Daily News

Medicare conferees included language in a manager's statement accompanying the Medicare reform bill stating that retiree plans can scale back benefits for Medicare-eligible beneficiaries, even though AARP successfully killed legislative language specifically allowing such differential treatment.

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