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Medicare

September 23, 2019 | Daily News

A group of Democratic senators is pressing CMS to step up its oversight of Medicare Advantage plans, pointing to problems with MA plan overpayments, provider directory and encounter data accuracy issues and potentially misleading star ratings.

September 20, 2019 | Daily News

Home health providers, Medicare advocates and hospitals again expressed concerns that CMS’ proposed 8% cut within the home health system based on behavioral assumptions is too harsh in its proposed 2020 home health pay rule.

September 19, 2019 | Daily News

A summary of House Speaker Nancy Pelosi’s (D-CA) long-awaited government drug price negotiation bill says that savings from the plan, unveiled Thursday (Sept. 19), could be used to add hearing, vision and dental benefits to Medicare.

September 19, 2019 | Daily News

The House on Thursday (Sept. 19) passed a short-term continuing resolution to fund the government through Nov. 21 and avert a government shutdown Oct. 1, and the Senate reportedly will take up the CR next week.

September 19, 2019 | Daily News

Democratic presidential primary candidate Pete Buttigieg’s newly unveiled “Medicare for All who want it” proposal would create a public option with auto-enrollment, increase exchange subsidies and cap out-of-network costs at twice the Medicare rate.

September 19, 2019 | Daily News

Providers are asking CMS why the first bonus payments for those in alternative payments models through the Quality Payment Program have yet to be paid, even though providers in the Merit-based Incentive Payment System started seeing their pay adjustments at the start of the year.

September 19, 2019 | Daily News

House Speaker Nancy Pelosi (D-CA) on Thursday (Sept. 19) unveiled her long-awaited government price negotiation plan, which would give HHS the power to negotiate drug prices that would apply to all payers.

September 18, 2019 | Daily News

A package of so-called health extenders was tucked into the continuing resolution introduced in the House late Wednesday (Sept. 18) to avert a government shutdown Oct. 1.

September 18, 2019 | Daily News

House Speaker Nancy Pelosi (D-CA) will release a bill Thursday (Sept. 19) that directs Medicare to negotiate prices for at least 25 drugs, and up to 250 drugs, according to lawmakers who have been briefed on the bill.

September 18, 2019 | Daily News

Traditional Medicare remains the driver of risk-based pay models, according to a report released by Premier Inc. Tuesday (Sept. 17), but a Premier official said progress is slower than the hospital group had hoped for as few providers surveyed expect their total patient percentage in these models to exceed 50% within five years.

September 17, 2019 | Daily News

A federal judge on Tuesday (Sept. 17) said CMS lacked authority to impose deep reimbursement cuts for clinic visits at certain off-campus facilities.

September 17, 2019 | Daily News

House Speaker Nancy Pelosi (D-CA) is expected to release her long-awaited government drug price negotiation plan on Wednesday (Sept. 18).

September 17, 2019 | Daily News

Providers and patient advocates are calling on lawmakers to back a bill limiting prior authorization in Medicare Advantage, but the insurance lobby is pressing policymakers not to impose any statutory restrictions on the process.

September 17, 2019 | Daily News

Mental health and substance use treatment advocates are calling on Congress to reauthorize funding for mental health clinics, remove barriers to medication-assisted treatment and allow mental health counselors to bill Medicare.

September 13, 2019 | Daily News

Plans say prior authorization for medication-assisted treatment (MAT) for individuals with substance use disorders helps the treatment be used safely and effectively, but providers are worried that prior authorization is a barrier to treatment in the middle of an opioid crisis.

September 13, 2019 | Daily News

Justice in Aging and the National Consumer Voice for Quality Long-Term Care are urging others to “speak out for nursing home residents” by opposing CMS’ proposed rule to ease nursing home regulations, and the groups have developed sample comments that lay out why the agency shouldn’t move forward with many of the rule’s proposals.

September 12, 2019 | Daily News

CMS Administrator Seema Verma told hospitals on Tuesday (Sept. 10) that the agency will have to tackle the high costs of hospital care in order to drive down total health care costs, even though she previously told reporters the agency was not planning to target hospital spending.

September 12, 2019 | Daily News

Lawmakers and administration officials are slowly backing away from the White House’s promise to roll out a large-scale Affordable Care Act replacement plan and are instead saying the president is focusing on smaller-scale items such as drug pricing and surprise billing, and will take another look at protecting coverage for preexisting conditions if the courts overturn the health law.

September 12, 2019 | Daily News

The National Association of Accountable Care Organizations (NAACOS) called on CMS to pay close attention to what it sees as a dip in the number of new ACO participants for 2019 and lays out recommendations that could help entice new organizations to join the program.

September 12, 2019 | Daily News

Health care issues made up a large portion of the first two Democratic debates as candidates parried over their respective visions on universal health coverage, and some Democratic strategists say the candidates in tonight’s debate need to also make clear that the Trump administration has been working to undermine the existing law, both through regulatory moves and by backing a lawsuit that aims to scrap the Affordable Care Act.

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