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CMS will allow MA plans to implement step-therapy requirements for Part B drugs

August 13, 2018


Under a new CMS policy, Medicare Advantage plans beginning Jan. 1, 2019, will be able to implement step-therapy requirements for prescription drugs administered to beneficiaries at physician offices or hospitals—and President Trump says his administration soon will announce more policies intended to lower prescription drug prices.

Payment bumps and price transparency requirements: Inside CMS' 2,610-page IPPS final rule

August 3, 2018


CMS' final rule for the Inpatient Prospective Payment System and Long-Term Acute Care Hospital (LTCH) Payment System for fiscal year 2019, which overhauls the meaningful use program and aims to improve hospital price transparency, will affect about 3,300 acute care facilities and about 420 LTCH facilities.

CMS finalizes payments bump for post-acute care, hospice providers

August 2, 2018


CMS' final rules for skilled nursing facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities will increase payments to the facilities by a total of $975 million for fiscal year (FY) 2019, while a separate final rule will increase Medicare payments for hospices by a total of $350 million for FY 2019.

Hospice has grown in popularity—and it's vulnerable to fraud, HHS' OIG finds

August 2, 2018


CMS says, "The agency takes the oversight role of the Medicare hospice program seriously and is aggressively focused on reducing and eliminating fraud, waste, and abuse."

CMS projects Part D premiums will drop for 2nd year in a row

August 1, 2018


CMS estimates that the average basic premium for Medicare Part D plans will decline in 2019 for the second consecutive year, from $33.59 to $32.50.

Centene, Ascension eye joint MA plan

August 1, 2018


Centene says it has signed a letter of intent with Ascension to launch a joint Medicare Advantage plan that would be "a preferred model" for the insurer and for providers in the Ascension health system, which is the largest nonprofit health system in the United States.

Sanders' 'Medicare for All' bill would cost $32.6T—and change who is footing the bill

July 31, 2018


An analysis from the Mercatus Center at George Mason University estimates that Sen. Bernie Sanders' (I-Vt.) so-called "Medicare for All" proposal would cost about $32.6 trillion in new spending over the first decade—which observers say is slightly lower than what the United States is projected to spend on health care over the next ten years under its current health care system, though the proposal would shift who pays for the costs.

CMS wants to expand site-neutral payments. Here's what that means for providers, patients.

July 31, 2018


CMS' recently proposed rule to expand site-neutral payments under Medicare, if finalized, could mean Medicare would pay providers at outpatient departments the same as providers at regular doctor's offices for identical procedures, whereas they currently could be paid different rates for the same procedure.

Verma says 'Medicare for All' would really mean 'Medicare for None'

July 27, 2018


CMS Administrator Seema Verma says Democrats' push to implement a so-called "Medicare for All" single-payer health system in the United States could undermine Medicare beneficiaries' care, but Sen. Bernie Sanders (I-Vt.) says, "Medicare has worked extremely well for our nation's seniors and will work equally well for all Americans."

CMS looks to expand site-neutral payments, 340B cuts in latest Medicare payment rule

July 26, 2018


CMS' proposed rule to update the Hospital Outpatient Prospective Payment System for calendar year 2019 would, among other changes, reduce reimbursements for clinical visits at all off-campus hospital outpatient departments to about $46.

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