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Medicare

August 06, 2004 | Daily News

CMS' proposed drug rule has done little to allay state concerns that the benefit's clawback calculation may not accurately reflect all 2003 drug rebates, a scenario that would leave states paying out more money to the federal government.

CMS' July 26 regulation signals no solution to the states' key concern that not all 2003 rebates will be paid by drug manufacturers in time for the clawback calculation. The drug benefit gradually transfers the drug costs of dual eligibles from Medicaid to Medicare but claws back most of the savings.

August 05, 2004 | Daily News

The Medicare drug benefit implementation blueprint issued by CMS last week appears to give some low-income residents in a handful of states back-door access to federal help with their drug costs even if they officially fail to qualify for the financial aid.

August 05, 2004 | Daily News

CMS' proposed roadmap for Medicare's new prescription drug benefit suggests prescription drug plans may have to meet electronic prescribing standards as early as 2006 -- three years faster than originally specified.

CMS included language in its proposed drug rule, issued July 26, requiring plans to be able to support final CMS e-prescribing standards -- including those established before the drug benefit takes effect in 2006. CMS says it intends to mandate a "starter set of well-established standards" by the time drug coverage begins.

August 04, 2004 | Daily News

Pharmacy Plus drug coverage programs will not be allowed to fill in the gap in coverage in the part D prescription drug benefit and the four states currently running them should therefore direct their Pharmacy Plus spending toward state pharmaceutical assistance programs (SPAPs) which can do so, CMS says in its newly proposed rule for the January 2006 drug benefit.

August 04, 2004 | Daily News

CMS actuaries have added $30 billion to their five-year projected cost for private Medicare plans and hiked estimates of per-capital drug expenditures by $11 billion as part of revised estimates included in the mid-session budget review released by the Office of Management and Budget (OMB) this week.

August 03, 2004 | Daily News

CMS will soften the blow to hospitals facing lower Medicare payments next year because of redrawn labor market boundaries, according to the final inpatient rule issued yesterday (Aug. 2).

August 03, 2004 | Daily News

Facing widespread opposition from hospitals and pressure from Capitol Hill, CMS has backed off a proposal to curtail admissions to long-term care hospitals from the host hospitals where they are located, deciding on a four-year phase-in that would ultimately set more flexible restrictions on admissions to hospital-in-hospitals.

August 02, 2004 | Daily News

In an effort to maximize the number of employers that retain retiree drug coverage and opt to receive a tax-free subsidy for drug costs, CMS is considering a series of options that give employers greater ability to shift premium costs onto retirees.

August 02, 2004 | Daily News

The process to develop model guidelines for the new Medicare drug benefit is coming under fire for a lack of transparency from a range of stakeholders, including those handpicked to serve on advisory forums, despite recent efforts by U.S. Pharmacopeia (USP) to make public the process it has conducted behind closed doors since early May. USP officials defend the process, pointing to an upcoming opportunity for public comment after the draft guidelines are released next month.

July 30, 2004 | Daily News

Nursing homes will receive a full 2.8 percent market basket increase for next year's Medicare reimbursements and will retain temporary add-on payments pending long-promised reforms to their payment classifications. The fiscal year (FY) 2005 fee schedule for skilled nursing facilities (SNFs) issued today (July 30) is estimated to increase provider payments $440 million.

July 30, 2004 | Daily News

A major Florida homecare company is threatening to drop its Medicare lung disease patients on the eve of the presidential election, after CMS issued a proposed rule slashing payments for inhalation drugs and indicating any compensatory fee would be limited and of short duration.

Lincare Holdings Inc. said its decision to continue to serve patients with chronic obstructive pulmonary disease hinges on the adequacy of the dispensing fee CMS sets to make up for cuts of about 90 percent in the reimbursement for drugs dispensed through nebulizers.

July 29, 2004 | Daily News

The proposed Medicare physician rule issued this week includes a supplying fee for immunosuppressive, anti-cancer and anti-emetic drugs set at less than a quarter of the level sought by specialty pharmacies.

July 29, 2004 | Daily News

Physicians will see their Medicare reimbursements for drugs reduced next year, but the cuts can be significantly mitigated if CMS updates its codes for administering drugs and biologicals, according to the proposed 2005 physician fee schedule rule issued Tuesday (July 27). The proposed rule calls for some steep reductions in drug reimbursements due to the new average sales price (ASP) payment rate mandated by the Medicare Modernization Act (MMA).

July 28, 2004 | Daily News

CMS is planning to require smoke detectors in every nursing home resident's room after congressional investigators examining two multiple-fatality fires criticized the agency for lax oversight. CMS' plan-of-attack has drawn support from a key Senate nursing home watchdog, but nursing home advocates are dismayed the fatalities have not led to an official call for sprinklers to be swiftly installed in all nursing homes.

July 28, 2004 | Daily News

Despite a statutory prohibition against interfering in price negotiations between drug manufacturers and Medicare drug plans, CMS plans to assess the aggregate prices drug plans pay for "groups" of drugs to judge whether their bids for government subsidies are justified.

July 27, 2004 | Daily News

A Bush administration proposal for the disabled would have been blocked in Congress even without its controversial offset provision trimming federal funds from state Medicaid programs, according to Medicaid Director Dennis Smith.

July 27, 2004 | Daily News

The power wheelchair industry is embracing a federal court ruling stipulating that CMS cannot require Medicare durable medical equipment (DME) suppliers to submit additional medical documentation beyond the certificate of medical necessity (CMN) to prove that an item is needed.

In a ruling against HHS, the federal court said suppliers only have to use a CMN to make the case for medical necessity, and that HHS cannot require suppliers to submit medical records or make judgments on whether the equipment is medically warranted.

July 26, 2004 | Daily News

The proposed rule for the 2006 Medicare drug benefit issued by CMS Monday (July 26) presents both policy options and open-ended requests for stakeholder input on implementation issues that will impact both Medicare beneficiaries and the competing commercial interests, such as drug manufacturers, pharmacy benefit managers, drug stores, and nursing home and home health pharmacies.

July 26, 2004 | Daily News

Armed with a $25 million funding carrot, CMS is calling for interest from states keen to take part in a pilot program testing criminal background checks on new long-term care workers.

The agency last week issued a solicitation notice seeking applications for the demonstration program, which was mandated by the Medicare reform law. CMS plans to divvy up $25 million to up to 10 states selected to trial background check programs through the end of fiscal year 2007.

July 23, 2004 | Daily News

CMS is proposing that hospitals ask emergency room patients their citizenship status to document the facilities' eligibility for a Medicare Modernization Act $1 billion fund designed to defray hospitals' expenses for uncompensated care for undocumented immigrants. The proposal, which is still subject to public comment and possible revision, rejects early advice from hospitals and immigration advocates that asking undocumented immigrants about their citizenship status could deter them from seeking needed care.

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