On June 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released one of their two annual Reports to Congress.[1],[2] The report includes recommendations to revise Medicare Advantage (MA) benchmark policy, streamline the portfolio of alternative payment models (APMs), replace the existing skilled nursing facility value-based purchasing program, revise indirect medical education (IME) payments, and improve [...] Read More
On the evening of December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final Physician Fee Schedule (PFS) for calendar year (CY) 2021. The rule includes finalized policies related to telehealth, the Quality Payment Program (QPP), care management and others. Provisions of this final rule become effective on January 1, 2021. [...] Read More
On the afternoon of November 20, 2020, the Trump Administration released an interim final rule with comment period (IFC) from the Centers for Medicare and Medicaid Services (CMS) to implement a mandatory, seven-year payment model called the Most Favored Nation (MFN) Model. This model will initially include a group of 50 single source drugs and [...] Read More
On the evening of October 28, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, fact sheet, and an unpublished interim final rule with comment period (IFC) on its website related to the COVID-19 public health emergency (PHE). The IFC interprets and implements CARES Act requirements regarding COVID-19 immunizations and treatments, [...] Read More
On the evening of October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) released the unpublished version and fact sheet of its proposed CY 2021 Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) rule, which updates DMEPOS coverage and payment policy for CY 2021: Classifies/establishes payment amount for continuous glucose monitors (CGMs) as [...] Read More
CMS has released the CY 2021 proposed Physician Fee Schedule (PFS). This proposed rule includes policies for payment to physicians as well as Medicare Part B policies. Comments on the proposed rule are due on October 5, 2020. CMS Likely to Finalize Medicare Physician Fee Schedule Provisions in December Typically, CMS releases its Medicare Physician [...] Read More
Following the release of an HHS report on international drug pricing, President Trump announced a new Department of Health and Human Services (HHS) initiative to index pricing for Medicare Part B drugs to international prices. The advance notice of proposed rulemaking solicits comments on a demonstration program HHS is considering that would test changes to [...] Read More
Overview The Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS) has released a report entitled “Comparison of U.S. and International Prices for Top Medicare Part B Drugs by Total Expenditures.” The report comes as the Trump administration continues to implement its “American Patients [...] Read More
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
This afternoon, CMS released amounts for hospital and physician services deductibles and cost-sharing for Medicare beneficiaries for 2018: Inpatient Hospital Deductible: $1,340 (+$24 from 2017) Inpatient Hospital Daily Coinsurance: $335 (Days 61-90) (+$6/day from 2017) $670 (lifetime reserve days) (+$12/day from 2017) Extended Care Services in a Skilled Nursing Facility: $167.50 (Days 21-100) (+$3/day from […]
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