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Medicare

October 04, 2018 | Daily News

CMS innovation center chief Adam Boehler told accountable care organizations on Thursday (Oct. 4) the agency should offer models with simplicity, predictability and transparency, but participating providers need to be held accountable for their care -- and, if not, others are waiting to take their place in the system.

October 04, 2018 | Daily News

The White House budget office is reviewing the final physician fee schedule and Part B pay rule, with stakeholders bracing for the possible inclusion of controversial drug-pricing measures.

October 04, 2018 | Daily News

Pharmacy benefit managers support recommendations by congressional Medicare advisors to update the defunct Competitive Acquisition Program in Part B, but with a twist: PBMs want Medicare administrative contractors to be vendors that subcontract with PBMs to negotiate drug prices.

October 04, 2018 | Daily News

Congressional Medicare advisers say the Competitive Acquisition Program could be used for negotiating prices of drugs administered at inpatient hospitals, and they point to the debate over expensive CAR-T cancer drugs as an example of why CMS might want to expand the scope of the program, should it be revived, beyond outpatient settings.

October 04, 2018 | Daily News

An array of stakeholders voiced their support for the cross-industry role laid out in a set of sweeping cybersecurity initiatives unveiled by FDA Commissioner Scott Gottlieb this week, including new cybersecurity information sharing agreements, a playbook for hospitals to prepare for cybersecurity breaches and plans for an updated agency guidance document.

October 04, 2018 | Daily News

Brand-drug makers' lobbying maneuvers in their failed bid to get Part D donut hole changes included in the opioid legislation could factor into an expected new push by the industry for the changes during the upcoming lame-duck session of Congress.

October 03, 2018 | Daily News

CMS on Wednesday (Oct. 3) unveiled several changes to the local coverage determination process, including a way to request such a determination, repurposed public meetings and a reconsideration process that is consistent with that used for national coverage determinations.

October 03, 2018 | Daily News

The Senate cleared a massive bicameral package of opioid legislation on Wednesday (Oct. 3) by a vote of 98-1, with Sen. Mike Lee (R-UT) as the sole “no” vote, and Sen. Ted Cruz (R-TX) not voting.

October 03, 2018 | Daily News

Despite earlier concerns that a draft handbook distorted the facts around traditional Medicare and Medicare Advantage in favor of the private plans, Medicare beneficiary advocates say CMS has made improvements to the final “Medicare & You” handbook for 2019 that make it more accurate and unbiased, including incorporating several of the groups' suggested edits.

October 01, 2018 | Daily News

CMS Administrator Seema Verma said changes to the Medicare website for the 2019 open enrollment, including a beneficiary out-of-pocket cost calculator that is optimized for mobile devices, are meant to help provide beneficiaries with information they need to make decisions, but was adamant the agency is not attempting to steer beneficiaries into Medicare Advantage rather than traditional Medicare.

October 01, 2018 | Daily News

A California-based physician association owned by DaVita Inc. will pay $270 million to the federal government to settle allegations that it submitted inaccurate information about its patients in order to inflate Medicare Advantage payments, the Department of Justice announced Monday (Oct. 1).

October 01, 2018 | Daily News

In a win for the dialysis industry, California Gov. Jerry Brown (D) on Sunday (Sept. 30) vetoed legislation (SB 1156) that would have limited dialysis pay in commercial insurance to Medicare levels for patients who receive premium assistance from industry-funded charities.

September 28, 2018 | Daily News

CMS announced Friday (Sept. 28) that it will extend for one year the ability of Medicare-eligible seniors who were enrolled in exchange coverage to switch to Part B coverage without a penalty.

September 28, 2018 | Daily News

The Supreme Court agreed Thursday (Sept. 27) to hear a case that could define the extent of CMS’ authority to issue legal interpretations that affect Medicare payment policies without going through notice-and-comment rulemaking.

September 28, 2018 | Daily News

A top American Hospital Association official warns that CMS could face a lawsuit if it proceeds with a proposal to level payments for clinic visits between some hospital off-campus facilities -- which were previously exempt from such cuts -- and physician offices.

September 28, 2018 | Daily News

HHS on Friday (Sep. 28) announced about $2.6 million in prize money for the KidneyX: Redesign Dialysis competition, and Ed Simcox, HHS chief technology officer, said at a briefing that the while the prize competition can encourage innovation, coordination between FDA and CMS to improve patient access will also be part of the KidneyX initiative.

September 27, 2018 | Daily News

California Gov. Jerry Brown (D) has until Sunday to veto legislation (SB 1156) that would limit dialysis pay in commercial insurance to Medicare levels for patients who receive premium assistance from industry-funded charities, but his intentions remain unclear.

September 26, 2018 | Daily News

The final version of opioid legislation excludes brand-drug industry-backed Part D changes, and now brand lobbyists have set their sights on the lame-duck session for getting Congress to lower the industry’s share of seniors’ drug costs.

September 26, 2018 | Daily News

Bicameral negotiators left out of the final opioid legislation a pay-for that would have extended the time kidney-failure patients could stay on private insurance.

September 26, 2018 | Daily News

Pharmacists will be allowed to tell customers when it is cheaper to fill prescriptions without insurance after the president signs legislation the House has sent to him banning so-called gag orders.

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