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Medicare

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.

March 05, 2004 | Daily News

CMS will miss a March 7 deadline for setting up an interim drug coverage program established by the Medicare Modernization Act and will not tally the savings on currently-covered drugs to stretch the program's $500 million budget as lawmakers had demanded, House and industry sources told Inside CMS .

March 05, 2004 | Daily News

The House Energy and Commerce Committee will oversee implementation of the new Medicare reform law as one of its top health care priorities, the panel's new chairman Joe Barton (R-TX) has announced.

March 04, 2004 | Daily News

CMS is still weighing how it will decide two key questions for its upcoming proposed rule on the Medicare prescription drug benefit -- whether it will require more than one drug in each therapeutic class in drug plan formularies and whether the legislation legally bars it from negotiating on prices and formularies if there are government-run fall-back plans.

CMS Acting Deputy Administrator Leslie Norwalk said the agency was still mulling both questions for the proposed rule it has targeted for release in June.

March 04, 2004 | Daily News

Congressional estimators believe that permitting HHS to negotiate prices on some single-source drugs under Medicare's new pharmacy benefit could yield savings, arming Democrats with new firepower in their campaign to ax language in the Medicare reform law that prohibits the federal government from trying to wrestle lower drug prices.

March 03, 2004 | Daily News

The House Energy and Commerce Committee's deputy staff director and chief health care council, Patrick Morrisey, is leaving Capitol Hill to join the food and drug law firm Sidley, Austin, Brown and Wood.

The firm's clients include drug and biologics industry heavyweights the Pharmaceutical Research and Manufacturers of America and Biotechnology Industry Organization. Morrisey will start at Sidley, Austin in a few weeks, he told FDA Week.

March 03, 2004 | Daily News

The Medicare prescription drug benefit offers new opportunities to make health care, and prescription drugs in particular, more affordable, the Bush administration nominee for CMS administrator said. FDA Commissioner Mark McClellan faces a Senate Finance Committee hearing March 8 on his nomination to head CMS.

McClellan told the National Medicare Prescription Drug Congress last week he would maintain the same focus on affordability at CMS that he used at FDA, where he pushed to make it easier and faster for new drugs to come to market.

March 02, 2004 | Daily News

Rehabilitation therapy providers and congressional staff have begun to informally discuss policy options that could provide a less costly alternative to outright repeal of a cap on outpatient therapy services once a two-year moratorium on the cap expires in 2006.

The dialogue includes staff on both House and Senate committees of jurisdiction as well as lawmakers in both chambers who have spearheaded efforts to repeal the cap, which limited outpatient therapy to around $1,500 a year for all patients.

March 01, 2004 | Daily News

Nearly two years after a federal court scolded CMS for altering a mandated Medicare+Choice (M+C) deadline and beneficiary education mailer, the agency is still continuing to pay for its actions.

March 01, 2004 | Daily News

Pharmaceutical manufacturers are offering sizable rebates to sponsors of the new Medicare prescription drug card in order to ensure the success of the program -- a precursor to the Medicare drug benefit -- in advance of the fall presidential elections, according to representatives of the pharmacy benefit managers planning to offer the cards.

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