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Medicare

February 09, 2004 | Daily News

The large-scale chronic care pilot program authorized by the new Medicare reform law calls for financial results, not just clinical ones, and it will be run like a commercial function of Medicare, a CMS official said.

The entities awarded contracts for the pilots will assume fiscal risks for saving Medicare sums at least equal to the fees they are paid by the system if not more. They will also be evaluated by three more-traditional markers: beneficiary satisfaction, clinical improvement and health care quality improvement.

February 09, 2004 | Daily News

Medicare quality improvement organizations (QIOs) will have expanded duties in their next round of contracts that will likely include helping physician practices broaden their work to include additional preventive services and chronic care services -- two areas emphasized in the recently enacted Medicare law.

February 06, 2004 | Daily News

Congress has instructed CMS to broaden the definition of vital "blood products" so as to protect life-saving plasma products such as intravenous immune globulin (IVIG) from deeper reimbursement cuts and users from subsequent access problems. The push by Congress, included in the Omnibus spending package, follows on the heels of a similar recommendation last year by an HHS advisory committee.

February 06, 2004 | Daily News

CMS has received over 100 applications from entities seeking to offer Medicare's new prescription drug discount card, Bush administration officials have announced, including bids by retail and community pharmacists who blocked previous Medicare card plans from going forward.

February 05, 2004 | Daily News

The switch next year to an average sales price benchmark for physician-administered drugs will give generics an edge where they compete with equivalent brand-name drugs, setting a reimbursement rate that will overpay physicians for the generics while under-reimbursing them for more expensive brand-name drugs.

February 04, 2004 | Daily News

CMS plans to ensure employers retain drug coverage at least as good as the new Medicare benefit in exchange for new subsidies when it implements the Medicare prescription drug law provisions on retiree drug coverage, according to CMS Acting Deputy Administrator Leslie Norwalk.

February 04, 2004 | Daily News

Pharmacy benefit managers and insurers charge a CMS requirement that drug discount card sponsors include a drug in each of 209 separate categories will hurt their ability to negotiate discounts from drug makers, but drug manufacturers are pushing for rules that would lead cards to cover more drugs, particularly innovative new treatments.

February 02, 2004 | Daily News

Anxiety over deficit spending could finally whet Congress' appetite for levying a fee on certain Medicare provider claims and appeals, HHS Secretary Tommy Thompson has suggested.

The Bush administration's fiscal year (FY) 2005 budget request again proposes establishing user fees, even though Congress has resisted previous calls by the administration to impose the levies as a way to help fund CMS' program management budget. However, Thompson indicated to reporters today (Feb. 2) that lawmakers might now be more open to the idea.

February 02, 2004 | Daily News

A rise in prescription drug use by seniors and a delay in the ability of drug plans to negotiate cheaper prices account for a quarter of the extra $100 billion CMS has added to the tab of the new Medicare prescription drug benefit compared to the $400 billion cost projected by the Congressional Budget Office.

February 02, 2004 | Daily News

CMS has given rural critical access hospitals (CAHs) the go-ahead to expand to 25 beds for acute care, the first step in a process established under last year's Medicare reform law that will allow these small rural facilities to almost double in size by including new psychiatric and rehabilitation facilities.

As part of its rural health package, the Medicare law boosted payments and eased restrictions on these small hospitals, whose maintenance is considered critical for access in isolated rural communities.

February 02, 2004 | Daily News

The Medicare reform law's mandate to bring the payment system for ambulatory surgical centers (ASCs) in line with the reimbursement formula for hospital outpatient services is prompting an effort by ASCs to ensure they are not disadvantaged under the new system and to urge Congress to set the new rules through legislation.

February 02, 2004 | Daily News

AARP is throwing its weight behind a provision in the new Medicare reform law calling for HHS to compare the clinical effectiveness of health services, primarily prescription drugs. The political health care heavyweight is lobbying to try and secure funding for the measure, which it believes holds great promise for the battle to rein in drug prices.

January 30, 2004 | Daily News

This year's congressional health care debate will see a GOP focus on using tax incentives to cover the uninsured, while Democrats revive attempts to expand Medicare eligibility, but technical corrections to the Medicare reform law will have to wait until 2005, according to congressional health care staffers.

House Democrats will reintroduce legislation to allow persons under the age of 65 to join Medicare early as an alternative to the Bush administration's proposal to provide tax credits for lower-income Americans to buy private health insurance.

January 30, 2004 | Daily News

AARP wants CMS to strengthen its requirements that drug discount card sponsors post drug pricing data on the Internet, putting the nation's largest seniors' group at odds with insurers who are urging the agency to scale back web-based pricing requirements.

January 30, 2004 | Daily News

The insurance industry is pressing CMS to abandon its call for Medicare discount card sponsors to post negotiated prices on all of their covered drugs on the Internet. The move puts insurers at odds with the nation's largest seniors' group, which wants CMS to require that even more pricing data be put on the Internet.

January 28, 2004 | Daily News

FDA chief Mark McClellan appears to be emerging as a possible frontrunner to replace former CMS administrator Tom Scully as the head of Medicare and Medicaid -- a job switch that could put him in good standing for the top HHS spot should Tommy Thompson leave at the end of the year and President Bush win re-election, sources say.

January 28, 2004 | Daily News

The prospect of a year-long partisan slugfest over last year's Medicare prescription drug benefit is making it increasingly unlikely that there will be any technical corrections to the mammoth law and leading Democrats to scrutinize whether CMS' extensive beneficiary education -- including a planned TV commercial for the new drug benefit this summer and fall -- accurately describes the new benefit.

January 23, 2004 | Daily News

Medicare quality improvement organizations (QIOs) are poised to expand into a new role consulting with health care providers on the new drug benefit but may not be able to renew their contracts as easily if CMS decides the QIO system is uncompetitive.

January 22, 2004 | Daily News

Oncologists and drug makers affected by the Medicare bill's revamping of the outpatient drug reimbursement are gathering data on the legislation's impact on access and will likely hold off on pushing a technical corrections bill until next year, according to industry sources.

Dissatisfaction with the reforms to the average wholesale price system (AWP) are widely viewed as the engine for a technical corrections bill, but the House engineers of the Medicare reforms have discounted the possibility of such a measure anytime soon.

January 21, 2004 | Daily News

A coalition of pharmacists Jan. 21 urged HHS Secretary Tommy Thompson to review CMS' decision not to pay a separate dispensing fee to compensate pharmacies for cuts in reimbursement for currently covered pharmaceuticals.

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