New Proposed CMS Medicaid and CHIP Managed Care Rule Targets Access, Quality, and Payment Rates
A newly released proposed rule by the US Centers for Medicare and Medicaid Services (CMS) targets transparency, quality, care access, and payment rates for Medicaid and Children’s Health Insurance Program (CHIP) managed care. States would need to provide an annual payment analysis of all managed cares payment rates for a variety of services. In addition, states will need to develop a quality rating system for Medicaid and CHIP plans.
Healthcare Price Transparency Rules Haven’t Helped Patients Yet
Despite a recently implemented rule requiring insurers to disclose what they pay for different kinds of care, patients have yet to benefit. The Centers for Medicare and Medicaid Service (CMS) also requires healthcare systems to do similarly. Unfortunately, a patient advocacy org has found these rules have not driven down health care prices for patients.
Analysts Suggest Impact of Drug Pricing Reforms Would be Limited
Despite a litany of complaints and concerns from the industry, the new US drug pricing reform passed by the Democrats would have a marginal impact on pharma, according to analysts from the Bank of America and UBS. The legislation will allow Medicare to set Part D prices for some medications, 10 by 2026 and 60 by 2029. In addition, the Centers for Medicare and Medicaid Services (CMS) will be able to negotiate part B prices.
US Government Accountability Office Report on State-Directed Medicaid Payments in Managed Care
The US Government Accountability Office (GAO) released a new report on state-directed payments of Medicaid funds to managed care plans. [...]
Lawmakers Call for Better CMS Oversight of Medicare Advantage Plans
Lawmakers in the US House of Representatives have expressed their concerns over the Center for Medicare and Medicaid Services’ (CMS) [...]
Biogen Ends Aduhelm Study Due to Medicare Restrictions
Biogen has ended its observational ICARE AD real-world data (RWD) trial for Aduhelm, another in a long series of setbacks [...]
US Supreme Court Won’t Hear UnitedHealth’s Medicare Advantage Lawsuit
UnitedHealth was handed a major setback Tuesday, June 21st, when the US Supreme Court declined to hear its lawsuit over [...]
Politico: CMS Wasn’t Built for a Pandemic
Despite mandating infection-control measures in hospitals, the Centers for Medicare and Medicaid Services (CMS) haven’t been able to enforce them. [...]
NASP Supports Biden Administration’s Rx Drug Cost-cutting Measures for Seniors but Seeks Protections for Pharmacies
Sheila Arquette, RPh, CEO and President of the National Association of Specialty Pharmacy (NASP), has praised efforts by the Biden [...]
Why Linked Healthcare Data is the New Research Standard
Real-world data (RWD) are data relating to patients’ health or health care, which are routinely collected from several [...]
CMS Announces Drug Payment Reductions with the “Most Favored Nation” Effective January 1, 2021
Centers for Medicare and Medicaid Services (CMS) announced the long-awaited seven year Most Favored Nation (MFN) model as an interim [...]
CMS expects MA, Part D payments to grow by nearly 3% in 2022
According to an advanced rate notice, the Trump administration expects Medicare Advantage (MA) and Part D payments to rise by [...]
COVID-19 Vaccine Will Come At No Cost to Medicare Beneficiaries
Once approved, the Trump administration will cover COVID-19 vaccinations at no cost to Medicare beneficiaries. On Wednesday, CMS released an [...]
Accountable Care Organizations Generate $1.19 billion in Savings to Medicare
CMS recently announced that accountable care organizations generated $1.19 billion in total net savings to Medicare in 2019, proving the [...]
RAND Report On Health Costs Raises Employer Ire
According to a new RAND study, the Centers for Medicare and Medicaid Services (CMS) are getting the sweetest deal on [...]
CMS Streamlines Compare Websites With New Care Compare Website
The Centers for Medicare & Medicaid Services (CMS) officially launched Care Compare, a patient-facing website streamlining all CMS Compare websites [...]
New CMS Proposal Aims to Expand Coverage for Breakthrough Devices
On Monday, the Centers for Medicare and Medicaid Services announced a proposed rule that would provide four year coverage for [...]
Proposed change to CMS Rules Aim Will Expand Access to High-cost Therapies for Medicaid Recipients
The Medicaid Best Price rule requires drug manufacturers to give Medicaid the best price on all purchases. However, the rule [...]
Real-world Evidence Put to the Test: Medicare’s New Codes for Remdesivir
The Centers for Medicare & Medicaid Services (CMS) has created new ICD-10-PCS procedure reimbursement codes to facilitate the generation of [...]
NPC: CMS Proposed Rule Hinders Value-Based Arrangements
In a letter to the Centers for Medicare and Medicaid Services, the National Pharmaceutical Council (NPC) outlines some key issues [...]
Datta: CMS Proposal a ‘Grab-bag of Issues’
Sidley Austin LLP's Meena Datta told HealthLeaders that the Centers for Medicare and Medicaid Services' (CMS) latest proposal is a [...]
Zemcik, Fry Spotlight CMS Best Price Proposal
Commercial Solutions' Rick Fry and TrialCard's Jason Zemcik spotlight the Centers for Medicare and Medicaid Services' best price proposal in [...]
Bach Outlines ‘Gaping’ Loophole in Medicaid Proposal
A Centers for Medicare and Medicaid Services proposal includes a "gaping" loophole through which drugmakers could avoid selling drugs to [...]
Report Reveals Racial Disparities in COVID-19 Outcomes
New data released by the government on Monday suggests black Americans under Medicare were roughly four times more likely as [...]
CMS Implements Harsher Penalties for Nursing Homes Amid Pandemic
The Centers for Medicare and Medicaid Servicies (CMS) is implementing stiffer penalties for nursing homes which are repeatedly caught violating [...]
