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Medicare

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.

March 15, 2004 | Daily News

CMS is looking at ways to ensure that seniors receiving drug-only coverage through state Medicaid programs do not see a reduction in benefits once the Medicare drug benefit comes on line in 2006, Acting Deputy Administrator Leslie Norwalk said last week.

March 15, 2004 | Daily News

The pharmaceutical industry's profit gains from the Medicare prescription drug benefit amount to less than one percent of the $1.7 trillion industry, even though price discounts from Medicare drug plans will not exceed those now negotiated by private insurers, according to a leading investment bank's estimates.

March 12, 2004 | Daily News

Missouri's top Medicaid official late last month told Acting CMS Administrator Dennis Smith that the agency is reneging on its promise to provide predictable funding through prospective reviews and is exceeding its authority in challenging the state's use of additional federal funds through intergovernmental transfers. Wider application of prospective reviews of state Medicaid budgets and tighter rules on IGTs are central to the administration's Medicaid agenda.

March 12, 2004 | Daily News

Congressional backers of a Medicare moratorium on specialty hospitals are cautioning CMS to abide by the intent of their legislative language, suggesting the agency take a close look at the provision before exempting facilities from the temporary ban.

Citing concern over apparent attempts to loosen the moratorium, Finance Committee chair Chuck Grassley (R-IA), ranking member Max Baucus (D-MT), John Breaux (D-LA) and Don Nickles (R-OK) have told HHS it is "vital" that the ban be enforced as Congress intended.

March 12, 2004 | Daily News

Senate Majority Leader Bill Frist (R-TN) promised to help facilitate a bipartisan reimportation bill in exchange for Sen. Byron Dorgan (D-ND) lifting the hold on Mark McClellan's nomination as CMS chief. The Senate confirmed McClellan today (March 12) by voice vote in the wee hours of the morning.

Frist has committed to form a group of senators from both parties to write a reimportation bill, a congressional source says. Frist's assurance means that this is "no longer a matter of whether a bill will be put together but how to do it so that everyone can agree," the source says.

March 12, 2004 | Daily News

CMS' new administrator said he is open to reviewing whether Medicare should cover off-label use of cancer drugs as part of an effort to make the program more cost-effective, a signal he will not accede to stakeholder pressure to automatically cover such uses, whatever the cost.

March 12, 2004 | Daily News

Despite pressure from the Senate Finance Committee's top Democrat, the Bush Administration nominee for CMS refused to commit to risk-adjust Medicare payments to private plans to account for their tendency to enroll healthier beneficiaries than fee-for-service (FFS) Medicare.

Congress' Medicare Payment Advisory Commission (MedPAC) last week recommended that CMS change its policy and adjust aggregate payments to Medicare Advantage (MA) insurers to account for the difference in health status.

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