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Medicare

December 18, 2020 | Daily News

The House on Friday evening (Dec. 18) passed a two-day stopgap continuing resolution that gives lawmakers the weekend to hammer out the details of a year-end package that wraps together spending and pandemic relief measures, and possibly also surprise billing legislation, health extenders and other key health policies.

December 18, 2020 | Daily News

CMS on Friday (Dec. 18) told hospitals that, starting in January, it will audit a sample of providers to make sure they are complying with the hospital price transparency rule -- which one attorney said signals CMS will be more proactive than expected in making sure hospitals follow the requirements.

December 17, 2020 | Daily News

As lawmakers continue to negotiate a year-end package, hospitals, doctors, nursing homes and home health providers are urging them to extend the moratorium on the 2% Medicare sequester cuts through the end of the COVID-19 public health emergency -- but some lobbyists say getting such an extension could be an uphill battle.

December 17, 2020 | Daily News

Stakeholders are hearing that provisions banning anticompetitive actions, included in the bipartisan Lower Health Care Costs Act (S. 1895) passed by the Senate health committee last year, might be wrapped into the final COVID-19 relief bill, but the final status is unclear.

December 17, 2020 | Daily News

CMS has pushed back the deadline for doctors to apply for extreme and uncontrollable circumstances exceptions from the Merit-based Incentive Payment System to Feb. 1, and is reminding providers that that process can include a request to leave out one or more performance categories from their score due to the COVID-19 pandemic.

December 16, 2020 | Daily News

National health care spending on hospitals and physicians increased in 2019, but that was offset in part by a decline in the net cost of health insurance that was driven by the health insurance tax moratorium.

December 16, 2020 | Daily News

The Trump administration on Tuesday (Dec. 15) asked a federal judge to reject the drug industry’s request for a temporary restraining order and preliminary injunction against the most-favored nation drug pricing demonstration.

December 16, 2020 | Daily News

The Trump administration on Tuesday (Dec. 15) asked a federal judge to reject the drug industry’s request for a temporary restraining order and preliminary injunction against the most-favored nation drug pricing demonstration.

December 15, 2020 | Daily News

CMS is laying out plans for a demonstration next year that will require inpatient rehabilitation facilities to submit their Medicare fee-for-service claims for pre-pay or post-pay review until they can show they have a good track record of correctly submitting claims, according to a notice published in the Federal Register Tuesday (Dec. 15).

December 09, 2020 | Daily News

The House on Wednesday (Dec. 9) passed a one-week government funding extension as lawmakers continue to negotiate a potential COVID-19 relief package and stakeholders push to get their priorities, like a fix for pay cuts to certain physicians and a continued moratorium on the Medicare sequester, into an end-of-the-year bill.

December 09, 2020 | Daily News

Former HHS Secretaries Donna Shalala and Kathleen Sebelius expressed confidence that President-elect Joe Biden’s HHS pick, Xavier Becerra, will gain enough bipartisan support to be confirmed, stressing that even though the California attorney general is a strong proponent of Medicare for All, he is a team player who will be dedicated to the less-aggressive policy of shoring up and building off the Affordable Care Act per Biden’s approach.

December 09, 2020 | Daily News

HHS’ latest application of the PREP Act allows doctors to provide certain COVID-19 pandemic-related services via telehealth across state lines -- effectively allowing the providers to avoid long-standing cross-state licensure requirements for a limited number of services.

December 07, 2020 | Daily News

The American Society for Radiation Oncology wants to work with HHS Secretary nominee Xavier Becerra on changes to the mandatory radiation oncology demonstration once the Biden administration takes office in January, and says it hopes the demo will be fixed before its new July start date.

December 04, 2020 | Daily News

The Pharmaceutical Research and Manufacturers of America and three groups representing doctors and patients filed suit Friday (Dec. 4) against the Trump administration’s demonstration that ties Medicare doctor reimbursement to foreign drug prices, and at press time the Biotechnology Innovation Organization was poised to file a separate suit in a federal court in California.

December 04, 2020 | Daily News

Congressional Medicare pay advisers discussed draft 2022 pay recommendations for post-acute care on Friday (Dec. 4) that don’t wrap in additional COVID-19 related payments, leading nursing homes to complain the advisers aren’t considering the long-term effects of COVID-19 and home health providers to assert the draft proposals if implemented would lead to closures.

December 04, 2020 | Daily News

The health insurance industry says that with COVID-19 surging and unemployment still twice as high as before the pandemic, the 116th Congress must act quickly with timely, targeted and temporary relief solutions, which include strengthening Medicaid and helping people to keep and afford their private coverage in addition to providing more funding for testing and vaccine distribution.

December 03, 2020 | Daily News

CMS on Thursday (Dec. 3) released the third part of its direct contracting demonstration, known as the Geographic Direct Contracting Model, or Geo, but the full-risk demo, which will require participants to take on risk for beneficiaries in an entire geographic region, won’t get started until well into President-elect Joe Biden’s term in 2022 under the agency’s timeline.

December 03, 2020 | Daily News

The most-favored-nation demonstration, which aims to lower drug prices, undermines price-competing biosimilars by subjecting them to international reference pricing, according to Coherus BioSciences, the maker of the biosimilar covered by the demonstration.

December 02, 2020 | Daily News

CMS will phase out its list of inpatient-only procedures over three years and will allow Ambulatory Surgical Centers to perform more procedures, under a final 2021 hospital outpatient pay rule out Wednesday (Dec. 2) that also updates how the agency will calculate hospitals’ star ratings.

December 02, 2020 | Daily News

CMS backed away from its proposal to increase cuts to Part B pay for 340B drugs by an additional 6% in 2021, citing the COVID-19 public health emergency, and instead finalized its alternative proposal to continue paying hospitals for those drugs at the Average Sales Price minus 22.5% as part of the final 2021 hospital outpatient pay rule.

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