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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.

'Silver-loading' helped save the ACA's exchanges in 2018. Now, the Trump admin might ban it.

April 16, 2018

Despite the predictions of many pundits last year, the Affordable Care Act's exchanges have not imploded—but analysts are raising red flags all over again in light of the Trump administration's plans for the 2019 open enrollment period.

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.

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.

HHS wants to delay the 340B overcharge rule. For the 5th time.

March 30, 2018

HHS is asking the White House Office of Management and Budget to once again delay the effective date of a yet-to-be-released final rule that would penalize drugmakers that deliberately overcharge providers for drugs purchased under Medicare's 340B drug discount program.

Maryland's unique experiment in all-payer budgeting is paying off, report finds

March 28, 2018

John McDonough, a health policy professor at the Harvard T.H. Chan School of Public Health, says Maryland's global budget pilot program for hospitals "is pretty bold and it's pretty thoughtfully done and has generated a huge amount of interest around the country."

Why 7 ACOs dropped out of Medicare's Next Generation ACO Model

March 28, 2018

Four of the seven accountable care organizations (ACOs) that withdrew from Medicare's Next Generation ACO Model say they left the program because of recent changes to the model's design.

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