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Medicare

February 27, 2004 | Daily News

HHS last week gave hospitals broad guidelines for providing free and discounted care to those in need, including rules for waiving Medicare co-payments, but hospitals remain uncertain how much they can publicize these policies without running afoul of anti-kickback laws.

February 27, 2004 | Daily News

Long-delayed coverage decisions for off-label use of expensive new anti-cancer drugs could indicate how CMS plans to determine whether it should pay for drugs when used beyond their FDA-approved indications.

The pending decisions have prompted both beneficiary groups and oncologists to seek input into the evidentiary standards CMS develops for coverage of off-label use of cancer drugs, which account for around half of prescribed treatments.

February 26, 2004 | Daily News

CMS' physician advisory council this week asked the agency for a series of stop-gap fixes to the Medicare formula for physician payment updates in the face of a looming payment cut once the Medicare law's minimum update expires in 2006.

The Practicing Physicians Advisory Council (PPAC) also called for CMS to incorporate provisions from last year's Medicare Modernization Act (MMA) that would alter the calculation of the sustainable growth rate (SGR) used to calculate physician reimbursement update.

February 26, 2004 | Daily News

Outgoing FDA chief Mark McClellan will head up a new inter-agency task force charged with tackling by year's end key issues central to whether HHS will ever move forward with drug reimportation. The task force will hold five stakeholder meetings to help it decide if drug reimportation could be done safely, how much such a system would cost HHS to oversee, what liability issues would be involved, and if the program should extend beyond Canada, HHS Secretary Tommy Thompson said this week.

February 20, 2004 | Daily News

Consumer advocates are petitioning a federal court to order HHS to release documents pertaining to the use of semi-skilled workers in nursing homes, claiming CMS repeatedly ignored their requests for the information. Advocates believe CMS' refusal to produce the data suggests it has no evidence to back up its much-criticized decision to let workers with minimal training feed nursing home residents.

February 20, 2004 | Daily News

Amgen has failed in a recent effort to get lawmakers to publicly endorse a contested interpretation of the Medicare reform law that would bar CMS from tying physician reimbursement of its anti-anemia drug to the lower cost of Procrit, which is made by its archrival Johnson & Johnson.

February 20, 2004 | Daily News

FDA food safety specialist Lester Crawford will be tapped as acting FDA commissioner when current FDA chief Mark McClellan moves over to head up CMS, the administration announced this morning. Crawford will be surrounded by three new acting deputies: Janet Woodcock, who has headed FDA's drug center for many years; Murray Lumpkin, a drug policy and international affairs expert in the commissioner's office; and Amit Sachdev, a former congressional staffer who has shepherded FDA's legislative affairs shop.

February 18, 2004 | Daily News

Various disease coalitions are vying for coverage under a $500 million demonstration by arguing that congressional intent behind the provision in last year's Medicare law points to coverage of drugs for their members.

February 18, 2004 | Daily News

Despite pressure from stakeholders for a quick start to a demonstration providing interim Medicare coverage for select self-administered prescription drugs, CMS may not be able to meet a March 8 deadline as it continues to wrestle with complex questions about the structure of the two-year program.

February 18, 2004 | Daily News

The American Society of Clinical Oncology has launched an effort to amend the Medicare reform law to stave off projected reimbursement cuts for cancer care, even as it acknowledged congressional leadership is reluctant to revisit the law and last year's fight over the issue had strained the group's relations with some lawmakers.

February 13, 2004 | Daily News

The HHS Office of Inspector General (OIG) is recommending wider use of a controversial policy setting Medicare reimbursement rates for the anti-cancer drug Lupron based on payment for a cheaper, clinically comparable competitor drug, arguing the move would save the program $40 million a year.

February 13, 2004 | Daily News

The chair of the Senate Finance Committee has called in the General Accounting Office (GAO) to assist the panel's probe of Medicare payments for power wheelchairs, citing fears that the program's reimbursement policy is providing easy pickings for fraudulent providers.

February 13, 2004 | Daily News

CMS has scheduled a listening session for power wheelchair providers, but the agency still has not promised to respond to industry complaints about restrictive new coverage policies issued by Medicare carriers.

February 13, 2004 | Daily News

President Bush is expected to within days announce FDA Commissioner Mark McClellan as the White House's pick to become the new CMS administrator, sources indicate.

For weeks the FDA head has been rumored to be the frontrunner to replace Tom Scully, who left his post as CMS chief in December. Several sources suggest Bush will soon nominate McClellan to the job, likely next week, according to another source.

February 12, 2004 | Daily News

A Bush administration plan to seek passage of a new budget enforcement law that would force any future changes to entitlement programs -- such as a Democratic push to close the gap in Medicare's new drug benefit -- to be paid with cuts to other entitlements programs has sparked debate. The administration's refusal to also require offsets for new tax cuts, which has aroused the opposition of Senate Democrats, could doom the proposal, according to Senate sources.

February 12, 2004 | Daily News

A House Democratic leader on Medicare policy is seeking a temporary freeze on Medicare reimbursements for new long term acute care hospitals, citing questions about their rising cost to the Medicare program and the possibility that nursing homes could serve as appropriate and cheaper substitutes.

February 11, 2004 | Daily News

CMS and Congressional Budget Office actuaries will face off in a March House Ways and Means Committee hearing designed to explore the basis for the extra $139 billion CMS tacked on to the cost of the prescription drug bill. The revelation last week of the higher cost projections also prompted Sen. Max Baucus (D-MT) to push for legislation requiring public disclosure of cost projections by the CMS actuary.

February 11, 2004 | Daily News

CMS has responded to pressure from congressional leaders by setting new criteria that could allow hospitals that dominate their local labor market and facilities next to higher wage areas to secure higher reimbursement through appeals of their wage index classification.

February 11, 2004 | Daily News

the new benefits and premiums flowing from the Medicare bill's boost to private plan payments in the face of renewed Democratic criticism that the law overpays private plans some $32 billion.

February 10, 2004 | Daily News

Families USA, a consumer group that opposed the Medicare reform bill, has enlisted Walter Cronkite -- one of the nation's most trusted figures -- to help front an upcoming campaign to educate seniors on what they can expect from Medicare's new prescription drug benefit. The move comes as Democrats continue their assault against the reform law with calls for separate investigations into the Bush administration's new Medicare advertisements.

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