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Archive Tag: medicare

Analysis of HHS-OIG’s Hospital Wage Index Report: OIG Cites Significant Vulnerabilities, Advocates for Legislative Change

On November 21 2018, Health and Human Services’ Office of Inspector General (HHS-OIG) released a report, titled “Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments”, which describes their examination of the wage index system for acute-care hospitals. The objective of their analysis was to identify “significant vulnerabilities” and propose solutions to […]

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MedPAC Reviews Draft Recommendations on Payment for Multiple Settings of Care, Moves towards New Quality Program for Hospitals

Overview On December 6-7, the Medicare Payment Advisory Commission (MedPAC) held a public meeting. This meeting began the annual process MedPAC conducts to review payment adequacy for physicians and the sites of care covered under the Medicare program. The meeting also included a discussion of redesigning hospital quality incentive programs and Medicare Advantage. Draft recommendations [...] Read More

Controversial Site-Neutral Payment Policy Finalized, 340B Payment Reduction Policy Expanded, Payment Increased for Ambulatory Surgical Centers

The final payment rule for hospital outpatient department prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for 2019 was released. The rule contains payment updates for hospital outpatient departments and ASCs as well as proposals related to pass-through payments and the 340B program. Highlights include: A new policy to reduce payments for clinic visits [...] Read More

CMS Finalizes CY 2019 Payment Update for Home Health Agencies, Establishes Transitional Payment for Home Infusion Services

Today, the Centers for Medicare and Medicaid Services (CMS) finalized its CY 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case Mix Adjustment Methodology Refinements. The rule implements a payment update, changes to the Home Health Value-based Purchasing Model (HHVBP), a new alternative case-mix model, and provisions related to home infusion therapy [...] Read More

MedPAC Holds First Public Meeting of 2019 Cycle

On Thursday, September 6 and Friday, September 7, 2018, the Medicare Payment Advisory Commission (MedPAC) met for its first public meeting of the 2018-2019 cycle. The meeting began with a presentation on the “Context for Medicare payment policy,” intended to orient Commissioners and set the scene for upcoming chapters. The presentation outlined existing and projected [...] Read More

CBO Underestimates Medicare Part D savings by $4 Billion Due to Oversight Lapse

In the Bipartisan Budget Act of 2018 the Congressional Budget Office underestimated – by $4 billion – the amount Medicare would save due to changes in Medicare Part D. Instead of saving $7.7 billion, Medicare will actually save $11.8 billion. The savings come from an increase in the government mandated discount that drug manufacturers must offer enrollees [...] Read More

Biosimilar Access and Savings: Ensuring a Reliable Reimbursement System

Here are some reimbursement related reasons why access to biosimilars has been slower than hoped, even though patient out-of-pocket costs are lower. Current System Is an Improvement Over Earlier System, But Could Be Better Part B Is For Biologics (and Some Drugs) When I was working at the Senate Legislative Counsel’s office drafting the Average [...] Read More

Senators Question HHS Secretary about Administration’s Drug Pricing Plan

This morning, the Senate Health, Education, Labor and Pensions (HELP) Committee held the first congressional hearing on President Donald Trump's plan to combat high drug prices, "American Patients First." The hearing featured testimony from Department of Health and Human Services (HHS) Secretary Alex Azar as well as questions from Committee members. Senators on both sides [...] Read More

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