Centers for Medicare & Medicaid Services Archives - Page 2 of 4

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 […]

New Requirements for Hospitals Pertaining to Chargemasters, effective January 1, 2019

Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule and 2019 […]

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

HHS to Require List Prices in Direct-to-Consumer Television Advertisement for Prescription Drugs

This afternoon, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule related to drug pricing transparency as part of the administration’s continuing effort to combat high drug prices. Comments on the proposed regulation are due on December 17, 2018. While the rule cites elements of the Social Security Act as the source […]

Modest Reduction in Average Premiums for Some Silver Plans Expected in 2019, Signs Market May Be Stabilizing

The Centers for Medicare and Medicaid Services (CMS) announced today that the average premiums for second lowest cost silver plans (SLCSP) available on the Exchanges will drop by 1.5% in 2019. This is the first year-to-year drop in average premiums since the Exchanges became operational in 2014. The data released today includes plans sold on [...] Read More

CMS Releases Proposed Rule Designed to Reduce Burden on Health Care Providers and Facilities

On September 17, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction.” The proposed rule was developed in response to President Trump’s executive order that instructed agencies to look for ways to reduce regulatory burden. The agency also notes that [...] 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

CMS Releases CY 2019 Proposed Payment Rule for Hospital Outpatient Departments, Includes Proposals Related to Site Neutrality, 340B, and Pass-Through Payments

On July 25, 2018, CMS released its CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment system proposed rule. The rule contains payment updates for hospital outpatient departments and ASCs as well as proposals related to pass-through payments and the 340B program. Three requests for information (RFIs), including two […]

Medicare Should Help Patients Avoid the Angst of an Incorrect Alzheimer’s Diagnosis

Every year, thousands of Americans hear the devastating news that they have Alzheimer’s disease. This diagnosis carries with it a certain future of declining mental and behavioral capabilities, and the eventual need for round-the-clock end-of-life care. The financial costs can be staggering, and the emotional costs immeasurable. While the impact of Alzheimer’s can be slowed, […]

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