Noteworthy News

 

Bill Seeks to Block 340B Cut

Legislation introduced in Congress would block the attempt by the Centers for Medicare & Medicaid Services to slash $1.6 billion in annual payments to hospitals for prescription drugs for outpatients prescribed through the federal section 340B prescription drug discount program. Earlier this month CMS finalized its plan to reduce controversial 340B payments and shift $1.6 billion in savings into Medicare provider payments.  If adopted, the bipartisan legislation co-sponsored by Representatives David McKinley (R-WV) and Mike Thompson (D-CA) would prevent the reduction of 340B payments, which are made to hospitals that care for especially large proportions of low-income patients. The 340B [&hellip

CMS Guidance on MCO Payments is Good News for Safety-net Hospitals

New guidance from the Centers for Medicare & Medicaid Services on the use of directing supplemental Medicaid resources to hospitals through Medicaid managed care organizations is good news for many urban safety-net hospitals across the country. In many states, new revenue generated by state hospital taxes (assessments) are routed through the state’s Medicaid managed care plans.  Recently, however, it has not been clear whether the federal government would permit continued use of this mechanism. An early November bulletin from CMS, however, clarifies that this approach is still permissible, which is good news for many urban safety-net hospitals located in states [&hellip

Medicaid Retroactive Eligibility: A Dying Policy?

A growing number of states are ending or limiting retroactive eligibility for Medicaid:  the practice of Medicaid reimbursing providers for the care they deliver to Medicaid-eligible patients for up to three months even if those patients had not previously enrolled in Medicaid. Arkansas, Indiana, and New Hampshire have ended the practice for some categories of Medicaid patients and Iowa joined them on November 1.  In addition, Delaware, Maryland, Massachusetts, and Utah impose some limits on retroactive Medicaid eligibility for at least some Medicaid-eligible individuals. While the purpose of retroactive eligibility ostensibly is to ensure a health care safety-net for low-income [&hellip

Administration Moving Away From Value Pay?

First, new Medicare programs for lump-sums payments for cardiac care and joint replacements were scaled back. Then, additional doctors were exempted from a new payment system that would have paid them more for the results they produce than for the quantity of care they provide. Next, the Department of Health and Human Services presented a document outlining a new direction for its Center for Medicare and Medicaid Innovation. And it announced that it was seeking input from doctors on payment policy. All suggest that if the Trump administration is not moving away for paying for quality rather than quantity it [&hellip

GAO Urges Medicare Action on Opioids

The Centers for Medicare & Medicaid Services is not doing enough to oversee the prescribing of opioids to Medicare beneficiaries. Or so concludes the U.S. Government Accountability Office. According to the GAO, CMS provides guidance to Medicare drug plans “…but does not analyze data specifically on opioids.”  Also, according to the GAO, …CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers.  As a result, CMS is lacking information that it could use to assess how [&hellip

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