In an effort to give insurers leverage for negotiation, Trump is advocating pulling protections guaranteeing Medicare coverage: Pharmaceutical companies that raise the cost of certain drugs risk losing protections that guarantee Medicare coverage, part of a Trump administration proposal to give insurers leverage to negotiate lower prices. The U.S. Centers for Medicare and Medicaid Services on Monday proposed exceptions to six protected classes of treatments for illnesses … [Read more...] about Administration Considering Pulling Medicare Coverage from Some Drugs to Encourage Negotation of Price
2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies
The Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data. According to the Press release: The 2019 Advance Notice is being published in two parts this year due to requirements in the 21st Century Cures Act, which mandated … [Read more...] about 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies
LTC News: No Medicaid Payments
-- Medicare Part D, 2014 -- "In a blow to Medicaid-certified long-term care providers in the nation's capital, officials announced the District of Columbia would not make Medicaid payments during the federal government shutdown." – McKnight's -- "In the two years since an 11.1% reimbursement cut for skilled nursing facilities hit, providers have regrouped and have achieved modest successes, the president of the American Health Care Association/National Center for Assisted Living told … [Read more...] about LTC News: No Medicaid Payments
News from CMS
>> CMS recently announced that a 60-day supplier bidding period for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies will begin at the end of October. (Source) CMS's Jonathan Blum said, "Competitive bidding is an essential tool to help Medicare pay appropriately for health care—important not only to maintain Medicare beneficiaries' access to high quality medical items and services, but also to lower the cost … [Read more...] about News from CMS
Extending Medicare Drug Coverage May Lower Other Costs
A recent study showed that extending Medicare Part D coverage to Medicare enrollees who previously had limited or no drug coverage may result in lowering other medical costs. (Source) According to the study, prescription drug spending for newly enrolled beneficiaries without previous coverage rose by $41 a month, $27 a month for those who'd had a $150 quarterly cap, and $13 a month for who'd had a $350 cap. The study also found that spending for other forms of medical care for the … [Read more...] about Extending Medicare Drug Coverage May Lower Other Costs
Pharmaceutical Industry Agrees to Cut Drug Costs
The Wall Street Journal reports that the pharmaceutical industry has agreed to cut the cost of Medicare drugs to prevent larger cuts President Barack Obama may impose to fund his health care reform plan. Under the cost-cutting plan, the drug industry would pay for half the Medicare drug's price when it's not covered by the gap under Part D. Over 10 years, pharmaceutical companies will sacrifice $80 billion by covering a larger share of brand-name prescription drug costs. The health care … [Read more...] about Pharmaceutical Industry Agrees to Cut Drug Costs
CMS News: Preventable Readmissons, Bidding Program Resumed
The Centers for Medicare and Medicaid Services (CMS) has announced a pilot program called the Care Transitions Project, designed to reduce preventable hospital readmissions. (Source) The national program, running through summer 2011 in 14 communities, will look at readmission rates at hospitals and develop ways to reduce readmissions. Acting administrator Charlene Frizzera said one in five patients leaving hospitals will be readmitted within the next month, and 75 percent of those … [Read more...] about CMS News: Preventable Readmissons, Bidding Program Resumed
CMS Quick Links for Tuesday
Last week the Centers for Medicare and Medicaid Services (CMS) announced that it would postpone implementation of a competitive bidding rule for durable medial equipment providers until April. CMS was required do another round of bidding and make changes, so the implementation date was pushed back. The comment period for the final rule ends on March 17, 2009. (Kaiser Network) CMS would like to make it easier for Medicare beneficiaries with conditions like epilepsy, mental illness, and … [Read more...] about CMS Quick Links for Tuesday
HHS: Medicare Part D Beneficiaries Overcharged
According to a report released by the U.S. Department of Health and Human Services Office of the Inspector General, private insurers under Medicare Part D have overcharged beneficiaries and taxpayers by billions of dollars since the program began in 2006. (Kaiser Network) An estimated 80 percent of private insurance companies owe Medicare $4.4 billion. The Centers for Medicare and Medicaid Services (CMS) has not conducted audits it should have performed in 2006. Consequently, CMS doesn't know … [Read more...] about HHS: Medicare Part D Beneficiaries Overcharged
Medicare Advantage and Part D Under Obama
Last summer, President George W. Bush vetoed a bill that would have halted a 10.6 percent Medicare physicians pay cut. Democrats proposed to reduce payments to Medicare Advantage (MA) plans to fund the physicians pay cut. President Bush reportedly vetoed the bill because it would "harm beneficiaries by taking private health plan options away from them" and urged Congress to send him a bill "that reduces the growth in Medicare spending, increases competition and efficiency, implements … [Read more...] about Medicare Advantage and Part D Under Obama
