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Medicare

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.

March 11, 2004 | Daily News

Clinical laboratories and medical device manufacturers are pushing CMS to use measures of access and quality, as well as cost savings to the Medicare program, in selecting the winners and evaluating the outcome of an upcoming demonstration project putting certain laboratory tests out for competitive bids.

March 11, 2004 | Daily News

In its annual March report, the Medicare Advisory Payment Commission (MedPAC) recommended that Congress eliminate the payment update for home health benefits in 2005, claiming the services enjoy comfortable margins, remain accessible to beneficiaries and the participation of home health agencies (HHAs) in Medicare has stayed steady. The General Accounting Office (GAO) also publicly released a report on the same day last week buttressing MedPAC's analysis by finding that Medicare payments to freestanding HHAs more than cover the costs of home health services for beneficiaries.

March 11, 2004 | Daily News

A new coalition of cancer care stakeholders has set an ambitious research agenda to monitor the impact of the Medicare Modernization Act's (MMA) reform of chemotherapy reimbursement in an effort to provide CMS and lawmakers with data they will accept as valid and unbiased.

March 10, 2004 | Daily News

The Medicare Payment Advisory Commission (MedPAC) last week recommended that Congress eliminate the scheduled market basket payment increase for skilled nursing facilities in 2005 and reallocate add-on payments from rehabilitation to other under-reimbursed services. Both proposals are opposed by nursing home providers.

March 10, 2004 | Daily News

The Finance Committee's top Democrat is poised to launch a legislative effort to protect Medicaid from spending cuts proposed in the fiscal year (FY) 2005 budget blueprint currently being debated by the Senate, according to sources.

At press time, Sen. Max Baucus (D-MT) was preparing to offer an amendment today (March 10) on the budget resolution that would strike the budget's Finance Committee reconciliation instructions, making it much less likely that $11 billion in assumed Medicaid cuts would ever happen, a Democratic aide said.

March 08, 2004 | Daily News

CMS is accepting nominations until Friday (March 12) for members of a commission to help guide the agency in coordinating the Medicare prescription drug benefit with existing state pharmaceutical assistance programs for low income seniors.

March 08, 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 08, 2004 | Daily News

CMS administrator nominee Mark McClellan promised Monday (March 8) at his Senate confirmation hearing to work with lawmakers on a reimportation bill. Key House and Senate lawmakers may introduce in a few weeks legislation that would give FDA additional authority and money to ensure the safety of imported drugs from Canada and possibly other countries.

March 05, 2004 | Daily News

CMS last week raised hospital reimbursements for intravenous immune globulin (IVIG) in response to complaints from stakeholders, who have begun to push the agency to boost physician and home infusion provider payments for the life-sustaining substance, arguing that Congress intended to exempt the life-sustaining from the Medicare law's cuts to the average wholesale price reforms.

March 05, 2004 | Daily News

With congressional estimators predicting sharp cuts to Medicare physician reimbursements starting in 2006, the House Ways and Means Committee is planning a series of hearings to investigate problems with the physician update formula in anticipation of a possible legislative fix in 2006, congressional sources said.

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