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August 22, 2016
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(1) Noncompliance with the Medicare physician supervision requirement has landed several hospitals and other providers in settlements with the government .... (more)
(2) Most industry eyes will be on California this Nov. 8, specifically a ballot initiative aimed at countering the growing costs of drugs .... (more)
(3) Before it’s even begun, the landmark Value-Based Insurance Design (VBID) model for Medicare Advantage plans that kicks off on Jan. 1, 2017, is getting a series of modifications for 2018 .... (more)
(4) Republican-led states are pushing back against HHS’s efforts to limit the use of short-term health plans, Modern Healthcare reported Aug. 9. On June 8, HHS issued a draft rule to limit short-term health policies to no longer than three months, instead of up to a 12-month term as is now allowed, and to end renewals of those policies (HEX 6/16, p. 4). The proposal was co-drafted by IRS and the Dept. of Labor. Restricting the use of inexpensive short-term policies would move more healthy people to the public exchanges. Since the early days of the ACA, the Obama administration has pushed to keep people from enrolling in non-ACA-compliant insurance. The agencies received more than 100 comments, “with states and insurance industry stakeholders voicing concern while health plans and patient advocates express support,” according to the article .... (From Inside Health Insurance Exchanges' E-Alert)
(5) The U.S. District Court for the District of Vermont has handed plaintiffs in Jimmo v. Burwell another victory over CMS .... (more)
(6) The Health Resources and Services Administration (HRSA) released a proposed rule on the administrative dispute resolution process under the 340B Drug Pricing Program (RIN 0906-AA90) on Aug. 12 .... (more)
(7) Medicare Advantage organizations may sue primary payers that refuse to reimburse the MAO for a secondary payment .... (more)
(8) Pennsylvania became the latest state to enact legislation focused on the dispensing of biosimilars that the FDA deems interchangeable .... (more)
(9) The Government Accountability Office (GAO) told Senate Finance Committee Chair Orrin Hatch (R-Utah) that while some states continue to explore tweaking Affordable Care Act (ACA) rules and standards under the so-called Section 1332 waiver process, the way federal rules are written may reduce actual applications to do so. The letter, made public on Aug. 8 and titled “Patient Protection and Affordable Care Act: Information on Approval Process for State Innovation Waivers, GAO-16-637R,” said “Stakeholder groups representing state Medicaid and exchange officials told us that…they believe HHS’s and Treasury’s application review controls and their operational considerations may considerably limit state waiver proposals,” GAO said. Section 1332 waiver requests can be submitted by states starting Jan. 1, 2017. The provision allows states, with CMS approval, to make significant changes to coverage and eligibility rules, such as the composition of essential health benefits or whether to have insurance coverage mandates .... (From Inside Health Insurance Exchanges' E-Alert)
(10) Medicare spent more than $24 billion in 2014 on Part B drugs, and most of those costs were based on the medications’ average sales price (ASP) .... (more)
(11) CMS’s improvements to the short-stay audits by the Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) are “nearly complete,” .... (more)
(12) The two sets of insurers being sued by the Dept. of Justice (DOJ) for their respective plans to combine will have separate trial dates, as requested, but the final decisions will come later than the insurers hoped .... (more)
(13) Medicare administrative contractors are supposed to review Part B outpatient drug claims to verify that Medicare pays for medications that qualify for coverage, and MACs use a variety of different sources to make these determinations .... (more)
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