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Groups ask CMS to stop dialysis facilities from steering patients into private health plans

April 18, 2018


A coalition of consumer groups, health care insurers, and unions are urging CMS to re-issue a final rule intended to stop dialysis facilities and other third parties from steering Medicare-eligible patients with end-stage renal disease into individual market plans in instances when the facilities or third parties either directly or indirectly have a financial interest in doing so.

After Paul Ryan: What's next for Medicare, Medicaid reform?

April 12, 2018


House Speaker Paul Ryan's (R-Wis.) announcement that he will not seek re-election in November is raising questions about whether Congress will achieve Ryan's long-sought goal to overhaul federal entitlement programs, such as Medicare and Medicaid.

Feds recovered $2.6B from health care fraud efforts last year, report finds

April 12, 2018


An HHS Office of Inspector General report finds the federal government recovered $4.20 for every $1 spent through the Health Care Fraud and Abuse Control Program during fiscal years 2015 through 2017.

CBO projects trillion-dollar deficits, rising spending on Medicare and Medicaid

April 11, 2018


The Congressional Budget Office report states that "health care costs per beneficiary are projected to grow faster than the economy over the long term, contributing to growth in spending for Medicare and Medicaid in particular."

Meet the new director of innovation for Medicare and Medicaid

April 9, 2018


Adam Boehler, the founder and former CEO of Landmark Health, beginning this week will serve as the new deputy administrator and director of CMS' Center for Medicare and Medicaid Innovation.

Medicare beneficiaries could have to pay nearly $80K for this new cancer drug

April 9, 2018


CMS says, starting April 1, it will reimburse Medicare providers a total of $395,380 for administering the gene therapy cancer treatment Yescarta to outpatients, meaning some beneficiaries could have to pay a nearly $80,000 co-payment for the drug.

MedPAC approves recommendations for freestanding ED payments

April 9, 2018


A draft recommendation that the Medicare Payment Advisory Commission approved last week calls for Congress to lower Medicare payments by 30% for off-campus, 24-hour hospital emergency departments (EDs) in urban areas that are located within six miles of an on-campus hospital ED.

Legalized marijuana may lead to fewer opioid prescriptions, studies find

April 4, 2018


New research suggests opioid prescriptions dropped in states where medical marijuana is legal—suggesting some U.S. residents might use marijuana to treat their pain as an alternative to opioids.

What's changing in Medicare Advantage and Part D next year: A 3.4% MA bump, 'hard' opioid limits, and more

April 3, 2018


CMS in 2019 will increase Medicare Advantage plan payments by 3.4% and set new pharmacy limits for Medicare Part D beneficiaries deemed at risk of opioid misuse.

ACOs were supposed to save billions. But did they actually raise federal costs by $400M?

April 3, 2018


An Avalere analysis finds accountable care organizations (ACOs) participating in the Medicare Shared Savings Program increased federal spending by $384 million from 2012 to 2016, but observers question whether the CMS data analyzed accurately represent ACO performance.

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