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January 07, 2004 | Daily News

Cardio-thoracic surgeons took a step forward in their longstanding effort to boost reimbursement for clinical staff assistants, securing language in the Medicare bill calling for the Medicare Payment Advisory Commission (MedPAC) to study if practice expenses of cardio-thoracic surgeons "adequately take into account the attendant costs of nurse assistants at surgery." The report, due by Jan. 1, 2005, is supposed to include recommendations for legislative or administrative action.

January 06, 2004 | Daily News

The new Medicare reform law double bills the program for care provided by teaching hospitals to enrollees in Medicare HMOs under a new payment system for HMOs that reflects add-on payments for indirect medical education (IME). But it remains unclear whether HMOs or teaching hospitals are the beneficiaries of the wrinkle in the legislation.

January 06, 2004 | Daily News

The new Medicare reform law gives emergency room physicians greater assurance they will be reimbursed for care that they provide in order to comply with statutory obligations to assess and stabilize patients seeking emergency room treatment.

January 05, 2004 | Daily News

Drug producers and patient advocates have begun lobbying CMS to cover specific cancer and multiple sclerosis drugs under a two-year demonstration program that must come under a $500 million budget cap.

The Medicare reform law mandates the program under Section 641, but does not specify which drugs or treatments will be covered, although cancer and multiple sclerosis are targeted for coverage until the full drug benefit takes effect in 2006. CMS has to implement the demonstration within 90 days of the law's Dec. 8, 2003, enactment.

January 02, 2004 | Daily News

Hundreds of rural hospitals made eligible for higher Medicare reimbursements for outpatient services by the recent Medicare reform law will not be able to receive the payment boost for much of 2004 because of the way the bill was written.

December 31, 2003 | Daily News

The recent Medicare law's reform of drug reimbursement, regional physician rates, and physician updates will add $1 billion to Medicare's 2004 outlays, according to a CMS rule released today (Dec. 31).

December 30, 2003 | Daily News

Two of the Senate's swing votes on the Medicare bill have asked the General Accounting Office (GAO) to keep tabs on pharmaceutical drug prices so as to monitor the effect of price hikes on the purchasing power of the new discount card and on the cost of the future drug benefit.

December 30, 2003 | Daily News

In the wake of landmark passage of a Medicare prescription drug benefit, AARP is now turning its attention to holding down drug costs, earmarking reimportation and evidence-based drug selection as key mechanisms it plans to work on this year.

December 22, 2003 | Daily News

Medicare conferees included language in a manager's statement accompanying the Medicare reform bill stating that retiree plans can scale back benefits for Medicare-eligible beneficiaries, even though AARP successfully killed legislative language specifically allowing such differential treatment.

December 22, 2003 | Daily News

Physicians stand to reap significant federal financial help and potential bonus payments from Medicare Advantage plans if they adopt the electronic prescribing approach laid out in the new Medicare drug law.

December 19, 2003 | Daily News

The much-touted free initial physical screening for new Medicare beneficiaries will be subject to copayments and deductibles under the new Medicare reform law, which may deter many beneficiaries from taking advantage of the screening services. The charges were tacked on to the provision in a compromise with Senate conferees opposed to the new benefit, congressional sources told Inside CMS.

December 19, 2003 | Daily News

On the eve of his departure, CMS Administrator Tom Scully said keeping good agency staff is critical to the successful implementation of the massive Medicare bill passed into law this month.

"I think the staff is great but I just hope we can keep the people around to get it done. I think there are a lot of good people here and if we keep the people we have and hire some more good ones I think it's do-able, but it's a hell of a lot of work," he told Inside CMS.

December 18, 2003 | Daily News

Two of the House authors of the newly enacted Medicare prescription drug benefit are seeking to refute criticism that the legislation does not allow insurers to cover gaps in coverage, but a manager's statement accompanying the legislation acknowledges the financing structure provides a disincentive for drug plans to close the coverage gap.

December 18, 2003 | Daily News

Boston Mayor Thomas Menino (D) is threatening to go ahead with a program to reimport drugs from Canada for city employees if FDA does not come up with a plan to allow for reimportation within six months. On Thursday (Dec. 18) Menino urged FDA officials to set up an advisory board to advise the HHS secretary on reimportation issues. Menino plans to follow up with the agency within 60 days.

Menino says the advisory board could help the HHS secretary with the study on reimportation required under the Medicare law.

December 18, 2003 | Daily News

The Congressional Budget Office (CBO) has downgraded its projections of the ability of future Medicare prescription drug plans to contain drug costs because of provisions in the newly enacted law outlining beneficiary rights to appeal formularies, requiring drug plan and manufacturer disclosure of drug price concessions and reducing the risk borne by drug plans.

December 18, 2003 | Daily News

Former CMS Administrator Tom Scully has taken on two jobs since leaving the agency this week, starting work as a policy advisor for the law firm of Alston & Bird in Washington, DC, and in the new field of equity investment for Welsh, Carson, Anderson and Stowe in New York.

Scully's move to the business side of the health care field with Welsh Carson, a specialist in acquisition of health care companies, is a new venture, but he hedged his bets by splitting his time with Alston & Bird, where his value as a policy advisor was assured, he told Inside CMS.

December 16, 2003 | Daily News

Still struggling with a negative fiscal outlook, states are worried Medicare's new drug benefit could diminish their pharmaceutical purchasing power under Medicaid -- one of the states' major tools in their battle to lower prescription drug prices.

December 15, 2003 | Daily News

Technical corrections to the mammoth Medicare bill President Bush recently signed into law are unlikely to take place next year, according to GOP congressional aides.

Many industry sources and observers are widely speculating that a technical amendment package will be pursued next year, but GOP aides are downplaying the possibility. "We think there's got to be a year cooling off period at least," one Republican source aide, adding that it is premature to talk of a technical corrections bill so soon after the legislation was passed.

December 15, 2003 | Daily News

The decision by Medicare conferees not to subsidize certain state pharmaceutical assistance programs for delivering the Medicare drug benefit means state governments will likely have to push seniors to sign up for a confusing new Medicare drug plan even if they are enrolled in state programs that provide superior benefits.

The recently passed bill will allow state programs to "wrap-around" the gaps in the Medicare drug benefit, amounting to significant savings for the costly state programs -- assuming that seniors will switch over to it.

December 11, 2003 | Daily News

Sen. Orrin Hatch (R-UT) is criticizing the 180-day generic drug exclusivity section of the drug patent reform provisions passed as part of the Medicare drug benefit. Hatch is floating a draft he claims will help fix a new "loophole" created by the new law.