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The long-running campaign to remedy Medicare's physician payment formula is regaining congressional momentum as a growing number of lawmakers in both chambers press CMS to make changes to the system.
Echoing a recent request by House Ways and Means Committee leaders, a group of bipartisan senators and congressmen are preparing to call on CMS to administratively alter the payment formula as a way to minimize physician cuts slated to begin in 2006.
A new analysis by CMS shows reduced prices offered to low-income beneficiaries under Medicare's drug card program, coupled with $600 in transitional assistance, can save seniors between 29 percent and 77 percent off a typical drug bill.
CMS television advertisements touting the new Medicare drug benefit that used actors posing as news reporters were covert propaganda that government agencies are legally prohibited from disseminating, the General Accounting Office found May 19.
As a result, the agency also violated laws against using appropriated funds for prohibited purposes, GAO said.
House and Senate budget conferees removed requirements for Medicaid cuts in the congressional budget released yesterday (May 19) but the budget projects reduced spending under the program over five years, according to a Democratic Budget Committee source.
The House bill included reconciliation instructions to the Energy and Commerce Committee to cut about $2.2 billion over five years, which would likely have come from Medicaid.
CMS has picked a contractor and a pharmacy benefit manager to run a demonstration providing interim drug coverage for oral cancer and other drugs and hopes to begin beneficiary enrollment by mid-July, CMS officials said yesterday (May 20).
CMS Adminstrator Mark McClellan today (May 20) sharpened the administration's crackdown on state efforts to boost federal Medicaid funds through certain financing mechanisms, proclaiming as "illegal" any intergovernmental transfer (IGT) in which states recycle federal dollars to increase their Medicaid matching funds.
The House has soundly defeated legislation by Rep. Dana Rohrabacher (R-CA) that would have required hospitals gaining special funding under the new Medicare law to report illegal immigrants they treat to the Department of Homeland Security.
The measure (H.R. 3722) was rejected 331-88 yesterday (May 18). The legislation was strongly opposed by hospitals, which argued it would turn them into "border patrol agents." It proposed new limits on hospitals seeking part of a $1 million dollar reform law provision to compensate facilities for their treatment of undocumented aliens.
The controversy over CMS' price tag for last year's landmark Medicare bill is set to dog the Bush administration until well after the November elections following a legal challenge lodged by House Democrats this week.
With less than six months until the polls open, the administration has been striving to tout the Medicare law as a domestic policy triumph but has faced repeated Democratic criticism, particularly for allegedly withholding its estimate that the law would cost $134 billion more than most lawmakers thought.
After losing their fight against new Medicare payment incentives that encourage four visits per month with dialysis patients, nephrologists are now battling CMS contractors who challenge reimbursement for the fourth visit on the basis of medical necessity. The nephrologists' complaint is part of a series of proposed amendments to the payment system for end stage renal disease that stem in part from how Medicare contractors are applying the system.
CMS' proposal last week to tighten admission criteria for long-term care hospitals operating within larger full-service hospitals could disqualify the majority of such facilities, according to an industry source. Hospitals-within-hospitals are the fastest expanding sector among long-term care hospitals (LTCHs), which provide the most extensive and expensive post-acute care to Medicare beneficiaries.
In a response to charges that their criticism of the Medicare discount drug cards is dissuading seniors from signing up, key Senate Democrats have introduced legislation to automatically enroll low-income Medicare beneficiaries in the program, forcing the issue into Republican hands.
CMS Administrator Mark McClellan says contractors running the upcoming disease management pilots will see reduced payment if they are not able to attract participation from physicians. Provider satisfaction, in addition to beneficiary satisfaction, is a payment criterion under the pilots, McClellan told lawmakers on the Ways and Means health subcommittee who questioned why CMS had not provided payment incentives to get physicians involved in the pilots.
House Ways and Means Committee chair Bill Thomas (R-CA) is pressing CMS to ensure that the shift of Medicare administrative law judges (ALJs) from the Social Security Administration (SSA) to HHS occurs before the implementation of the Medicare prescription drug benefit, but beneficiary and provider advocates remain concerned that Medicare appeals could be influenced by ALJs being under the same department as CMS.
An Inside CMS survey of the Medicare discount drug card prices posted Monday (May 10) generally shows only marginal improvement on the discounts CMS touted last week as providing substantial savings off retail prices for brand-name drugs, but at least one drug card has been able to get drug makers to match or beat the prices from generic competitors on drugs popular with seniors.
HHS is pushing ahead with a congressionally mandated study comparing the effectiveness of drugs and medical treatments and will meet next week with the public to discuss which items the project will tackle first.
Medco Health Solutions' $29 million payout to settle state fraud allegations will intensify state efforts to regulate pharmacy benefit managers (PBMs), sources close to the issue predict.
Medco recently agreed to pay 20 states and alter its business practices to settle allegations that it increased its clients' costs by encouraging doctors to switch patients to different drugs but did not pass on resulting savings. Insiders expect the settlement to fuel the growing state momentum for a legislative PBM clampdown.
Standardized electronic prescribing of Part D prescriptions could be achieved two years ahead of the compliance deadline set by Congress, according to CMS chief Mark McClellan.
The Medicare reform law stipulates that all Part D prescriptions electronically transmitted must conform to HHS standards by 2009 but McClellan last week said widespread electronic prescribing could be reached by 2006 or 2007.
The Senate Finance Committee is investigating if Medicaid is being overcharged for prescription drugs because pharmaceutical companies are violating congressional intent in their use of a Medicaid pricing exemption. The lawmakers' call for companies to hand over pricing policy data has upset some industry officials who fear the proprietary data could become public.
Attorneys general of 20 states are urging HHS Secretary Tommy Thompson to allow prescription drug importation under the newly enacted Medicare law. The AGs are asking Thompson to either allow states to be licensed wholesalers for Canadian drugs or allow states to contract with licensed wholesalers.
The HHS Office of Inspector General (OIG) has found Medicare overpays for drugs provided in dialysis facilities, but the margins vary greatly between smaller facilities and larger chains, especially for erythropoietin (EPO), which accounts for the lion's share of drug costs. The OIG's analysis of the acquisition costs for End-Stage Renal Disease drugs was mandated by the Medicare Modernization Act (MMA), which says the study should be used to reset Medicare reimbursement for drugs in 2005.
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