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Medicare

July 13, 2004 | Daily News

Two former congressional GOP health care staffers from key authorizing committees are fusing their talents in a new private-sector lobbying partnership. Dan Boston, currently with Baker, Donelson, Bearman, Caldwell & Berkowitz, will next month join forces with Monica Tencate, who previously headed the Senate Finance Committee's health care team.

Boston will leave Baker Donelson Aug. 1 to become partner in Tencate's Health Policy Source, Inc., which she has run since the beginning of 2002.

July 08, 2004 | Daily News

After a nine-month grace period, CMS is getting tough on providers submitting Medicare claims that do not meet federal standards for electronic transactions. The agency is using money to motivate providers to adopt the standards, announcing this week that payments for noncompliant claims will be delayed.

From July 1, electronic claims that do not meet Health Insurance Portability and Accountability Act (HIPAA) standards will be treated as paper claims and will take two extra weeks to get paid, according to CMS Administrator Mark McClellan.

July 07, 2004 | Daily News

Stepped-up CMS pressure on providers to document Medicare bills under an annual review of contractor oversight practices has reduced the number of non-responses from last year's high of 8 percent, according to a recent report by the HHS Office of Inspector General (OIG).

July 07, 2004 | Daily News

Signaling that the battle is far from over, specialty hospitals are launching their own investigation into the industry's impact on community facilities, a move designed to arm the industry with independent data for the future debate over banning physician self-referrals to boutique facilities.

The American Surgical Hospital Association (ASHA), the industry trade group, has commissioned a study that mirrors the Medicare Payment Advisory Commission (MedPAC) analysis mandated by the new Medicare reform law.

July 07, 2004 | Daily News

AARP continues to press the Bush administration to reconsider a ruling exempting retiree health plans from age discrimination law, but industry sources expect the administration will go forward with the controversial ruling after the November election in order to avoid a high-profile lawsuit by the powerful seniors group.

July 07, 2004 | Daily News

Key House Democrats are faulting an independent investigation into CMS' withholding of last year's Medicare cost estimates for not probing the White House's role in the affair and relying on administration lawyers in concluding that no laws were broken.

July 06, 2004 | Daily News

A substantial number of retiree plans will likely not meet the statutory test to receive special subsidies under the new Medicare drug benefit and instead will have to coordinate coverage with the Medicare drug plans under rules that will require them to assume the cost of catastrophic coverage if they are to still provide a generous drug benefit.

July 06, 2004 | Daily News

CMS has given Florida feedback on a draft waiver proposal that could fundamentally alter the state's Medicaid program by capping enrollment and instituting waiting lists, elevating fears by Senate Finance Committee leaders that CMS is negotiating major Medicaid reforms behind closed doors. Documents obtained by Inside CMS indicate CMS has provided feedback on a Florida proposal to put the state's entire Medicaid program under a demonstration waiver.

July 02, 2004 | Daily News

Medicare coverage of ultrasounds to help detect aorta defects promises to be one benefit change lawmakers will debate next year when Medicare resurfaces on the congressional agenda.

Four bipartisan lawmakers last week unveiled legislation directing Medicare to cover abdominal aortic aneurysm (AAA) screening, introducing the placeholder bill to help lay the groundwork for an intensive push for passage next year.

July 02, 2004 | Daily News

An association representing medical device manufacturers this week charged that CMS is prejudging the outcome of a pending coverage decision by indicating it will decide which heart patients should have access to the most sophisticated and expensive implantable cardioverter defibrillators (ICDs) and which need more basic, less expensive models.

July 02, 2004 | Daily News

CMS' aid package to rural ambulance providers that became effective yesterday (July 1) differs significantly from what the ambulance industry expected to receive, based on its internal estimates and methodologies. But the American Ambulance Association (AAA) is waiting for further information to be released before formally commenting on the interim final rule.

July 01, 2004 | Daily News

Arkansas lawmakers and the Congressional Black Caucus have joined with long-term acute care hospitals (LTACHs) in an effort to overturn a proposed CMS rule restricting the number of patient admissions these intensive care facilities can receive from the acute care hospitals in which they are located.

July 01, 2004 | Daily News

A week after the Supreme Court ruled that a federal law governing employee benefit schemes preempts state patients' rights protections, pharmacy benefit managers (PBMs) filed suit June 29 against a District of Columbia law regulating the industry, arguing it also falls under the purview of the federal statute.

July 01, 2004 | Daily News

A Medicaid bill that unites two legislative priorities for the disability community has been held up in the House because of partisan disagreements over whether and how to pay for it and may require pressure from the White House to save it, according to House sources.

June 30, 2004 | Daily News

Legislation introduced last week by the Senate Finance Committee's lead Democrat to tie Medicare payments for private plans and dialysis facilities to quality improvement measures has already sparked opposition from private plans to the legislation's proposal to fund quality incentives with a 2 percent cut in their base payment rate.

June 30, 2004 | Daily News

Manufacturers of 106 of the most common brand-name drugs used by seniors ratcheted up their prices by twice the rate of inflation in the lead-up to Medicare's new discount card program, AARP announced June 30. The price bump echoes similar manufacturer hikes imposed after congressional Medicare drug coverage action last summer and portends further increases in the run-up to Medicare's full drug benefit.

June 30, 2004 | Daily News

The HHS Office of Inspector General (OIG) has accused one of the country's largest nursing home pharmacy chains of paying kickbacks to guarantee Medicaid business from nursing home residents, demanding a record $21.8 million fine from the company and its 10-year exclusion from both the Medicare and Medicaid programs. The nursing home chain plans to challenge the OIG finding, a spokesperson for the parent company said.

June 25, 2004 | Daily News

Two of Congress' nursing home watchdogs are spearheading a congressional demand for HHS to immediately fix deficient data on a Medicare Web site designed to help families compare nursing homes after HHS' top official raised doubts about its reliability.

Rep. Henry Waxman (D-CA) and Senate Finance Committee chair Chuck Grassley (R-IA), together with Sens. John Edwards (D-NC) and Christopher "Kit" Bond (R-MO), today (June 25) asked HHS Secretary Tommy Thompson to swiftly outline a plan for remedying the data, citing serious concerns about its implications.

June 25, 2004 | Daily News

A CMS-run lottery will select about 25,000 Medicare beneficiaries with cancer and 25,000 with other diseases such as multiple sclerosis and rheumatoid arthritis to begin receiving coverage as soon as September for medications such as oral anti-cancer drugs and self-injectable biologicals.

But lawmakers from rural states have already complained that their constituents may be disadvantaged by such an approach.

June 24, 2004 | Daily News

CMS' effort to require pre-approval of states' Medicaid budgets is waning as the agency now may require such pre-approval on a voluntary basis in only some states that are given incentives to participate, according to a state Medicaid source.

The pre-authorization proposal started as an emergency regulation in January with only 24-hour notice and raised an outcry from states. HHS quickly committed to both a period of consultation with states and a proposed rule with a regular comment period.

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