Noteworthy News

Archive for July, 2015


GAO Reports on 340B Program

The U.S. Government Accountability Office (GAO) recently completed a review of the federal 340B Drug Pricing Program. The program, which requires pharmaceutical companies to provide drug discounts to qualified hospitals that serve especially large proportions of low-income patients, has come under fire recently because approximately 40 percent of U.S. hospitals now participate in the program and there have been questions about how hospitals use the program and its drug discounts. The GAO found that Medicare Part B spending on drugs was much higher at participating 340B hospitals than it was at non-participating hospitals, suggesting that participating hospitals prescribe more drugs [&hellip

Medicaid Cost-Sharing Re-Emerges

States are beginning to look anew at imposing cost-sharing requirements on their Medicaid population. Indiana now requires Medicaid recipients to contribute to health savings accounts, Arkansas and Iowa have cost-sharing requirements, and Arizona, Ohio, and Utah are considering introducing cost-sharing. This new trend is emerging after years out of favor when cost-sharing in Medicaid and children’s health insurance programs led to declining enrollment in Florida, Kentucky, New Hampshire, Oregon, and Wisconsin. The new “Healthy Indiana Plan” is receiving a good deal of attention for its use of health savings accounts instead of premiums and co-pays. People who put money in [&hellip

Medicare Proposes Changes in Two-Midnight Rule

The Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal for long-awaited changed in its controversial Medicare “two-midnight rule.” The changes, part of the agency’s proposed 2016 Medicare outpatient prospective payment system regulation released last week, include: changes in the standards by which inpatient admissions qualify for Medicare Part A payments a shift in responsibility for enforcement of the regulation, with Quality Information Organizations (QIOs) taking over from Recovery Audit Contractors (RAC auditors). changes in how long hospitals have to rebill for Medicare Part B services time limits on auditor requests for additional information about claims new limits [&hellip

Medicare Proposes 2016 Outpatient Payment Policies

The Centers for Medicare & Medicaid Services (CMS) has published its proposed Medicare outpatient prospective payment system regulation for calendar year 2016. Among the changes it has proposed are: a cut in outpatient rates clarification of chronic care management payments a restructuring of ambulatory payment classifications a new, single payment for observation services a 1.1 percent increase in ambulatory surgical center payments Perhaps most noteworthy, the proposed regulation presents the changes CMS envisions implementing in its controversial “two-midnight rule.” Find a CMS fact sheet on its proposed 2016 regulation here; a separate fact sheet on the two-midnight rule changes here; [&hellip

Medicaid Limits on High-Cost Drugs Illegal?

With the recent proliferation of high-cost drugs threatening many states’ Medicaid budgets, some of those states have attempted to impose limits on the use of those drugs. But are those limits legal? That is the question addressed in a new report in the Annals of Internal Medicine, which notes that Current restrictions seem to violate federal Medicaid law, which requires states to cover drugs consistent with their U.S. Food and Drug Administration labels. So are those limits legal? Or will patients and their advocates have grounds to challenge limits to their access to potentially life-saving or life-improving drugs? Learn more [&hellip

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