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Medicare

September 02, 2004 | Daily News

CMS is poised to approve a New York state proposal to offer managed care plans for beneficiaries of both Medicare and Medicaid even as it prepares official regulations for new plans to cover special needs groups, such as dual eligibles.

According to an issue brief by New Yorkers for Accessible Health Coverage (NYAHC), the state's "Medicaid Advantage" program will begin as early as Jan. 1.

September 02, 2004 | Daily News

CMS is proposing to end a controversial policy tying payment rates for two anti-anemia drugs made by rival drug makers, but the agency leaves itself a window for reviving the fight over its "functional equivalence" standard in the proposed hospital outpatient rule issued earlier this month.

September 01, 2004 | Daily News

In a show of widespread opposition, hospitals and advocates are pressing CMS to rework a draft agency proposal so that providers do not have to ask emergency room patients about their immigration status to qualify for a $1 billion handout designed to offset the cost of treating undocumented immigrants. Providers and advocates are calling on CMS to revise the proposal, arguing that the current plan would deter immigrants from seeking needed care and saddle providers with burdensome data collection requirements.

August 31, 2004 | Daily News

A House lawmaker spearheading legislation requiring all Medicare and Medicaid nursing homes to have automatic sprinkler systems believes the mandate has a shot of becoming law this year via a possible omnibus spending bill.

Rep. John Larson (D-CT) last week told reporters he is optimistic the sprinkler mandate can be added to any omnibus spending legislation Congress enacts later this year.

August 31, 2004 | Daily News

Community hospitals and their congressional supporters are ramping up the campaign to curtail the activities of physician-owned specialty hospitals, calling for House leaders to take swift action on the issue early next year.

August 30, 2004 | Daily News

The Bush administration is urging a federal court to throw out a lawsuit by House Democrats seeking access to CMS cost estimates for the Medicare Modernization Act (MMA), arguing that a ruling against the administration could sanction the release of any document Congress demands, even those classified for national security reasons.

August 30, 2004 | Daily News

Organized labor is pressuring CMS for more retiree protections in its regulations on how employers can qualify for subsidies to retain their prescription drug coverage plans once the Medicare drug benefit is launched in 2006.

August 30, 2004 | Daily News

CMS will have to decide whether to require Medicare drug plans to cover two drugs in each of the 135 specific categories that the United States Pharmacopeia (USP) believes could be adequately served by a single pharmaceutical, USP CEO Roger Williams told reporters after drug makers and disease advocates blasted the standard-setting body's model guidelines at an Aug. 27 public meeting.

August 27, 2004 | Daily News

Following widespread pressure, CMS is eyeing a change to Medicare's drug discount card enrollment process to make it easier for certain low-income seniors to receive a $600 federal drug subsidy available this year and next, informed sources say.

August 27, 2004 | Daily News

Shortly before sending out a recent letter to state Medicaid directors encouraging states to apply for home and community based services (HCBS) waivers, expansions of existing waivers, and to implement patient-directed care models , CMS approved an HCBS waiver expansion in Texas and a large patient-directed services waiver for California.

August 27, 2004 | Daily News

CMS is encouraging states to take advantage of existing policy flexibility to provide more long-term care service in beneficiaries' own homes in the absence of federal legislation to pay states to transition institutionalized patients back to their communities. In a letter sent to state Medicaid directors last week, CMS reminded states that they are welcome to apply for waivers and for expansions of their existing waivers, though they will not receive any extra federal funding for doing so as long as the legislation remains stalled on Capitol Hill.

August 26, 2004 | Daily News

With only five weeks remaining for beneficiaries to apply for the Medicare interim prescription drug coverage program for cancer patients and others, the program is likely to fall well short of the 50,000 participants CMS aimed to reach, knowledgeable sources say. The current pace of applications is slower than the agency had estimated, leading stakeholders to question whether the use of a controversial lottery to select enrollees will even be necessary.

August 26, 2004 | Daily News

CMS announced that it will propose draft standards for its review of Medicare drug plan formularies this fall as draft guidelines issued last week by an independent standard-setting body failed to set a standard guaranteeing beneficiaries access to many of their most commonly prescribed medications.

August 25, 2004 | Daily News

The Institute of Medicine is creating a panel of 15 experts to craft a national agenda for reducing medical errors, an IOM source says. The IOM study, called for by the Medicare reform law, will provide guidance to HHS agencies and Congress on the most cost-effective ways to improve drug safety. IOM will finish creating the panel in about two months, the source says.

August 25, 2004 | Daily News

Claiming 200,000 children could lose their federally funded health care, a bipartisan group of lawmakers is calling for swift congressional action next month to extend states' use of $1 billion of State Children's Health Insurance Program (SCHIP) funding set to return to the federal treasury. The legislative fix is backed by the nation's governors and a key House chairman but may hinge on finding an acceptable offset to bankroll the funding remedy.

August 24, 2004 | Daily News

Disability advocates are pointing to a recent CMS survey -- showing that 20 percent of nursing home residents would rather be treated in their homes or have community-based care -- as further proof that action should be taken to transition more Medicaid beneficiaries out of long-term care institutions and into their preferred settings. Since the Bush administration's efforts to do so federally are currently stalled in Congress, advocates hope to convince states to make changes individually.

August 23, 2004 | Daily News

The home infusion industry sees the proposed regulations on the Medicare Part D prescription drug benefit as a big opportunity to improve coverage of the drugs, supplies, and services it provides and plans to lobby hard to capitalize on CMS' proposals.

August 20, 2004 | Daily News

The Bush administration's blueprint for transferring the adjudication of Medicare appeals to HHS has sparked concern from beneficiary advocates and administrative law judges (ALJs) who believe it leaves the independence of ALJs and access to face-to-face hearings in doubt.

August 19, 2004 | Daily News

Hemophilia advocates plan to lobby for higher add-on payments for services associated with infusions of clotting factor therapies. CMS' proposed physician rule issued last month reduced reimbursements for clotting factor 15 to 30 percent, according to advocates, and instituted a separate add-on payment for furnishing the biological, which treats excessive bleeding.

An advocate said that the add-on, $.05 per unit of clotting factor furnished, is far too low to significantly mitigate the hit providers will absorb from the reimbursement cuts.

August 18, 2004 | Daily News

A key advocacy group for the mentally ill plans to lobby CMS to strengthen language in the agency's Medicare drug benefit rule to ensure that plans cannot disenroll individuals for disruptive behavior that is a result of their mental illness.

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