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Medicare

August 30, 2018 | Daily News

CMS innovation center director Adam Boehler on Thursday (Aug. 30) suggested accountable care organizations opting not to participate in the overhauled Medicare Shared Savings Program could pursue other value-based care avenues, including a direct-provider contracting initiative or bundled pay.

August 30, 2018 | Daily News

Republican leaders of the House Energy & Commerce Committee on Thursday (Aug. 30) asked congressional Medicare advisers to investigate the effects of hospital consolidation on rising Medicare costs, including prescription drug prices.

August 30, 2018 | Daily News

The House Energy & Commerce oversight subcommittee will hold a hearing Thursday (Sept. 6) to review abuse, neglect and substandard care in nursing homes, and federal efforts to make sure residents are safe.

August 30, 2018 | Daily News

The House Energy & Commerce health subcommittee will hold a hearing Wednesday (Sept. 5) to discuss the Advancing Care for Exceptional Kids Act, an extension of the Medicaid Money Follows the Person Demonstration, a bill to clarify the authority of the Medicaid Fraud and Abuse Control Units and legislation to codify the Healthcare Fraud Prevention Partnership.

August 30, 2018 | Daily News

The House Energy & Commerce health subcommittee will hold a hearing Sept. 5 on draft legislation banning so-called gag clauses in Medicare and the private market that prevent a pharmacist from telling a patient when it would be cheaper to buy a drug with cash rather than insurance.

August 29, 2018 | Daily News

CMS will allow indication-based formulary design in Medicare Part D starting in 2020, the agency wrote to plans Wednesday (Aug. 29).

August 29, 2018 | Daily News

Patient groups and doctors -- some of whom just signed on to the American Medical Association's push to get CMS to back away from proposed cuts to evaluation and management pay -- are asking CMS to discuss with stakeholders alternative ways to reduce paperwork that don't include its proposal to simplifying E/M coding.

August 28, 2018 | Daily News

CMS is negotiating with inpatient rehabilitation facilities to potentially settle Medicare appeals, HHS says in a recent court briefing, and additional settlement meetings with the IRF lobby are expected in the upcoming months.

August 28, 2018 | Daily News

HHS projects that recent settlements and increased funding from Congress should allow the department to eliminate the Medicare appeals backlog in fiscal 2022 -- assuming the higher funding level for the Office of Medicare Hearings and Appeals continues -- so the district court shouldn't require anything but status reports from the department.

August 27, 2018 | Daily News

More than 150 medical organizations, led by the American Medical Association, told CMS Administrator Seema Verma Monday (Aug. 27) that they oppose CMS’ proposal to simplify evaluation and management coding.

August 27, 2018 | Daily News

Congress should not use a measure that extends the time kidney-failure patients can stay on private insurance to help pay for House opioid legislation, insurers, unions and employers told Senate leaders, but patient groups praised the House legislation.

August 24, 2018 | Daily News

The HHS Office of Inspector General is asking for feedback on how to coordinate the anti-kickback and physician self-referral, or Stark, laws as well as how to set up safe harbors to help alternative pay models and the possibility of letting providers waive co-pays or provide other incentives to beneficiaries as a way to promote care engagement.

August 24, 2018 | Daily News

The Senate-passed “minibus” spending bill asks the Office of the National Coordinator for Health IT to update Congress on 21st Century Cures Act regulatory action relating to information blocking and the conditions of certification for health IT.

August 23, 2018 | Daily News

The White House budget office is reviewing a Medicare and Medicaid drug-price transparency proposed rule that could target brand drug makers, pharmacy benefit managers or both.

August 22, 2018 | Daily News

CMS will tweak a demonstration in order to continue allowing providers affected by state-wide moratoria on home health agencies and non-emergency ambulances to participate in Medicare, Medicaid and CHIP if there are proven access to care concerns, and the agency also will allow those that had a pending application denied when state-wide moratoria kicked in to participate in the programs through the demo.

August 21, 2018 | Daily News

The White House budget office finished reviewing a plan by the HHS Inspector General to seek advice from stakeholders on anti-kickback law reforms.

August 21, 2018 | Daily News

As CMS weighs national coverage policy for an expensive new CAR-T cancer treatments, Sloan Kettering's Peter Bach argues the agency has the ability to limit coverage until more data is collected on the therapy.

August 16, 2018 | Daily News

A group of hospitals lost a legal challenge to an old formula that CMS used to calculate so-called outlier payments intended to cover the treatment of patients who incur extraordinarily high costs.

August 15, 2018 | Daily News

The House Ways & Means Committee plans to send four letters to CMS highlighting ways to relieve administrative burden for hospitals, post-acute care providers, physicians and rural providers as part of its Medicare red tape relief project, but a new report from the committee includes no concrete plans for legislation despite Chair Peter Roskam's (R-IL) call earlier this year for legislative action this summer.

August 15, 2018 | Daily News

Senate Finance Committee ranking Democrat Ron Wyden (OR) and beneficiary advocates are raising concerns with CMS' star rating system for nursing homes, with Wyden saying beneficiaries and their families may not have accurate information on staffing and beneficiary advocates saying lower quality providers are using self-reported quality scores to inflate their overall star ratings.

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