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Medicare

August 23, 2019 | Daily News

CMS plans to vigorously defend in court its cuts to hospital pay for 340B drugs, but the agency is also weighing fallback options in case the D.C. Circuit Court of Appeals sides with 340B hospitals.

August 23, 2019 | Daily News

Hospitals have asked a federal court to update them on their lawsuit over deep reimbursement cuts for clinic visits at off-campus facilities after CMS last month proposed a 2020 hospital outpatient pay rule that doubled down on those cuts.

August 23, 2019 | Daily News

House Ways & Means Democrats are scheduled to meet Sept. 10 and 11 to talk about drug pricing and surprise billing legislation, and the committee might even mark up a bill mid-month, but it’s unclear which measures might be marked up or what they might entail.

August 23, 2019 | Daily News

Three former FDA commissioners are calling for CMS to test using data from multiple sources to gauge outcomes of value-based pay models for high-cost drugs and biologics.

August 22, 2019 | Daily News

Democratic staff of the House Energy & Commerce Committee are not negotiating on drug pricing with staff of the Senate Finance Committee, sources say, even though Finance Chair Chuck Grassley (R-IA) said bicameral drug-pricing talks would occur in August.

August 20, 2019 | Daily News

Provider groups praised a pilot unveiled last month by CMS that will give providers Medicare claims data, but at least one group worries that the pilot will increase provider burden.

August 20, 2019 | Daily News

Three Democratic senators are urging their colleagues to ramp up the traditional Medicare program to include more benefits, some of which are already offered by private Medicare Advantage plans, and the Center for Medicare Advocacy suggests that could be done by reinvesting what it calls wasteful spending on MA plans into new fee-for-service benefits.

August 19, 2019 | Daily News

CMS on Monday (Aug. 19) announced plans to update the way it calculates overall hospital quality star ratings -- with which hospitals have long raised concerns -- but, as it works on the changes, the agency will refresh the star ratings using the current methodology in early 2020, to hospitals’ disappointment.

August 19, 2019 | Daily News

CMS Administrator Seema Verma on Thursday (Aug. 15) said there are some areas of Medicare that scream for more utilization oversight -- and thus prior authorization -- but she also said prior authorization shouldn’t interfere with the practice of medicine or delay patient care, both issues about which providers have long complained.

August 19, 2019 | Daily News

America’s Health Insurance Plans defends prior authorization and tells CMS it is working with other stakeholders to streamline and improve the process -- though, unlike providers, the group doesn’t offer any suggestions for how CMS could help.

August 19, 2019 | Daily News

Providers are urging CMS to curb or streamline the use of prior authorization by Medicare Advantage plans, particularly through increased electronic prior authorization procedures, in response to the agency’s latest request for advice on how to cut back on administrative burdens.

August 17, 2019 | Daily News

Senate Finance Chair Chuck Grassley said Friday (Aug. 16) that Senate staff are pre-negotiating with House Democrats on drug-pricing legislation that could pass the lower chamber in a bid to pressure Senate Majority Leader Mitch McConnell (R-KY) to hold a Senate vote.

August 16, 2019 | Daily News

White House budget officials and the Pharmaceutical Research and Manufacturers of America are scheduled to meet Aug. 26 to discuss the Trump administration’s plan to tie U.S. drug prices to those in foreign countries, according to the Office of Management and Budget website.

August 16, 2019 | Daily News

CMS Administrator Seema Verma declined to say whether the Medicare International Pricing Index is a separate initiative from the so-called favored-nations executive order the president is writing to ensure the United States pays no more for drugs than other countries.

August 14, 2019 | Daily News

Seniors’ out-of-pocket maximum in Medicare Part D is set to increase 25% in 2020, and lawmakers have shown no indication that they will address the problem before the end of 2019.

August 14, 2019 | Daily News

The Government Accountability Office verified both drug makers’ assertions that the amount of rebates they pay is rising much faster than drug net prices and pharmacy benefit managers’ assertion that they pass nearly all rebates to their insurer clients.

August 13, 2019 | Daily News

Democratic presidential candidate and South Bend, Indiana Mayor Pete Buttigieg unveiled a rural health plan that closely mirrors that of other Democratic presidential candidates, including Sen. Elizabeth Warren’s proposals on reimbursement, telehealth and workforce disparities, and Sen. Michael Bennet’s call for CMS to adopt new payment policies to tackle social determinants of health.

August 13, 2019 | Daily News

Analysts at McDermott Will & Emery say that some health care watchers believe prior authorization-like programs will become increasingly common in fee-for-service Medicare after CMS proposed adding prior authorization to certain hospital procedures in the proposed outpatient hospital rule for 2020, though stakeholders note those requirements are for a fairly small and specific set of circumstances.

August 13, 2019 | Daily News

Democratic presidential candidate Sen. Kirsten Gillibrand (NY) released a rural health plan Wednesday (Aug. 7) that calls for expanding long-term services and supports (LTSS), but otherwise echoes the calls of other Democratic presidential candidates for more Medicare and Medicaid reimbursement and telehealth services as candidates increasingly focus on rural health in their presidential bids.

August 12, 2019 | Daily News

John O’Brien, HHS’ top drug-pricing official, is stepping down after nine months and will be replaced by John Brooks, the principal deputy director of the Center for Medicare and formerly a White House Domestic Policy Council official, HHS announced Monday (Aug. 12). The departure comes after several of President Donald Trump’s marquee drug-pricing policies were blocked or pulled in recent months.

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