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Medicare

March 26, 2004 | Daily News

Medtronic will file a formal request within a month for wider Medicare coverage of its implantable cardioverter defibrillator following completion of a study that purports to show millions of heart failure victims could lead longer lives if outfitted with the expensive device, according to a company spokesperson.

CMS Medical Director Sean Tunis plans to meet with the study's statisticians within a month and expects the agency will be able to process the coverage request before the statutory nine-month deadline kicks in, according to a CMS spokesperson.

March 26, 2004 | Daily News

CMS has given itself room for interpretation on which boutique hospitals it may exempt from a congressionally mandated moratorium on physicians' ability to refer Medicare patients to specialty hospitals in which they have a financial stake.

March 26, 2004 | Daily News

CMS will require contractors for its upcoming chronic care pilot program to have a well-developed plan for how they intend to engage and communicate with physicians, according to the CMS official in charge of the pilot.

March 26, 2004 | Daily News

CMS today (March 26) announced that Medicare Advantage HMOs would receive a minimum 6.6 percent rate increase in 2005, based on preliminary data. The agency also took two other steps that had the effect of boosting plan rates.

March 25, 2004 | Daily News

HHS Secretary Tommy Thompson said the White House did not pressure the chief CMS actuary to withhold cost estimates on last year's Medicare drug bill, predicting a probe by the HHS Office of Inspector General would focus on one incident involving an alleged threat from former CMS Administrator Tom Scully.

March 25, 2004 | Daily News

The CMS chief actuary revealed yesterday (March 24) he told the White House in early June that he projected the pending Medicare prescription drug legislation would exceed the $400 billion spending target by some $150 billion.

March 24, 2004 | Daily News

The $58 million that FDA's soon-to-be top official told lawmakers it would cost to set up a Canadian drug reimportation program was taken from an old forecast the agency helped make while offering technical assistance to Rep. Gil Gutknecht (R-MN) when he was writing reimportation legislation years ago, according to an FDA source. Even then agency officials estimated that a reimportation program would cost about $100 million once it was up and running, but the source says that figure likely does not come close to what it would cost now that more drugs are coming across the border.

March 24, 2004 | Daily News

Higher payments to rural hospitals and private plans under last year's Medicare reforms are a major factor in the accelerated depletion of the Medicare trust fund, which trustees this week predicted would empty its reserves by 2019, seven years earlier than last year's prediction.

March 23, 2004 | Daily News

A final rule by CMS to restrict which facilities qualify for the higher payments due inpatient rehabilitation facilities (IRFs) is expected to be released within two weeks, according to industry and Senate sources.

The draft final rule is still in HHS Secretary Tommy Thompson's office, according to a CMS spokesperson. Industry sources told Inside CMS that the rule is expected to be rapidly cleared by OMB.

March 22, 2004 | Daily News

Employers seeking subsidies for maintaining retiree drug coverage will only be able to count their contributions, but not the premiums paid by retirees, to meet the statutory test for the minimum level of benefits, incoming CMS Administrator Mark McClellan has told the Senate Finance Committee.

March 22, 2004 | Daily News

Outgoing FDA Commissioner Mark McClellan said Friday (March 19) the agency does not know what percentage of Canadian prescription drugs are made to FDA standards, but added that FDA is studying the matter because it is key to understanding if a Canadian drug reimportation program would be safe.

March 22, 2004 | Daily News

CMS is again expected to delay next month's scheduled shift to a prospective payment system (PPS) for inpatient psychiatric facilities, but stakeholders are more concerned with getting CMS to boost baseline payments under the new structure than with a prompt shift to a new system.

While the stakeholders are all looking forward to shifting from the current payment system, based on reimbursing "reasonable costs," they also hope to amend the PPS before its inception rather than attempt to revisit the system in the future.

March 22, 2004 | Daily News

Sen. Orrin Hatch (R-UT) is pressing CMS to finish up a review of the new Medicare payment system for physicians treating dialysis patients, raising concern that rural practitioners may be disadvantaged by linking reimbursement to multiple face-to-face visits. The review was requested by Congress in the omnibus spending bill that passed in January. CMS is not expected to modify the policy this year, according to the Renal Physicians Association (RPA).

March 19, 2004 | Daily News

The House Energy and Commerce Committee this week launched an attack on financing mechanisms used by states to draw additional federal Medicaid funds as the panel was charged with finding $2.2 billion in budget savings that are expected to come primarily from the Medicaid program.

March 19, 2004 | Daily News

In a major development, CMS has withdrawn a restrictive power wheelchair coverage policy clarification following intense pressure by stakeholders who argued that it would significantly impede Medicare beneficiaries' access to wheelchairs.

March 18, 2004 | Daily News

CMS is pushing to launch a pilot program to provide disease management services under Medicare by the end of March and will kick off a $500 million demonstration providing interim coverage of oral cancer and other prescription drugs in a matter of weeks, a senior CMS official told industry representatives this week.

CMS Chief Medical Officer Sean Tunis said the agency is aiming to launch the disease management program, mandated under Section 721 of the Medicare Modernization Act (MMA), "by the end of March." Tunis spoke at a March 16 open door forum on pharmacy issues.

March 17, 2004 | Daily News

Incoming CMS Administrator Mark McClellan is signaling the agency retains some discretion to link reimbursements to rival drugs providing equivalent therapies, saying the Medicare reform law's prohibition on future "functional equivalence" standards applies only to the hospital outpatient setting.

McClellan's interpretation of the Medicare Modernization Act (MMA) provision is the subject of a dispute between rival drug manufacturers Amgen and Johnson & Johnson and among the drafters of the law.

March 17, 2004 | Daily News

House Democrats are seeking a probe into possible legal violations by Bush administration officials responsible for withholding CMS cost estimates of the Medicare prescription drug bill and for threatening to fire the CMS actuary if he released estimates sought by lawmakers. The push comes a day after HHS Secretary Tommy Thompson asked for his own in-house inquiry and told reporters former CMS Administrator Tom Scully was responsible for providing lawmakers with the cost estimates.

March 16, 2004 | Daily News

Iowa's congressional delegation is casting a spotlight on CMS' process for approving state Medicaid amendments following claims the agency is holding changes to Iowa's Medicaid program hostage to the state's use of intergovernmental transfers (IGTs).

March 16, 2004 | Daily News

CMS will require Medicare prescription drug plans to provide at least two drugs in each therapeutic class, incoming CMS Administrator Mark McClellan informed Senate Finance Committee members late last week, adding that he expects most plans will cover all drugs although with differential beneficiary copayments.

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