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Judge Rules Site-Neutral Cuts Exceed CMS’ Authority

A federal judge ruled that the Centers for Medicare and Medicaid Services (CMS) exceeded its statutory authority by imposing reimbursement cuts to “grandfathered” hospital off-campus clinics. The D.C. District Court Judge Rosemary Collyer stated her ruling should not be difficult to implement given the site-neutral payments were not imposed in a budget-neutral manner. Following CMS’ finalization of the Calendar Year… (Slifer, 9/18/19) #Hospitals, #Physicians, #Delivery Reform

Updated Work Plan Focuses on Diabetes Test Strips, Specialty Drug Coverage and Hospital Reimbursement

The HHS OIG made a handful of updates to its Work Plan to reflect audits, evaluations and inspections that are underway or planned. Recently-added work include (1) the fifth in a series of OIG data briefs describing the Medicare market share of diabetic test strips (DTS) (this report will focus on Medicare market shares for DTS from April to June… (Pahner, 9/17/19) #Durable Medical Equipment, #Hospitals, #Prescription Drugs

Subcommittee Advances FY 2020 Agriculture FDA Funding Bill

The Senate Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies convened a markup of the fiscal year (FY) 2020 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies appropriations legislation. The Subcommittee approved $151.7 billion in funding ($87 million below the 2019 enacted level) by voice vote. The measure will be considered by the… (Llamas, 9/17/19) #Food and Drug Administration, #Prescription Drugs, #Nutrition

Report: Improper Payments for Emergency Medical Transports from Hospitals to SNFs

In a follow-up audit of Medicare emergency ambulance transport claims, the OIG found that providers improperly billed for emergency ambulance transports from hospitals to skilled nursing facilities (SNFs) on 99 percent of the total claim lines billed, yielding an estimated $849,170 in Medicare improper payments. The audit period included a sample of 8,800 claim lines for emergency ambulance transports that… (Pahner, 9/16/19) #Hospitals, #Skilled Nursing Facilities, #Ambulance, #Program Integrity

Report Examines Role of Rebates in Part D

An HHS OIG report finds that rebates “substantially reduced” the percentage increase in reimbursement for brand name drugs in Part D between 2011 and 2015. The report examine 1,510 brand name drugs. The OIG finds that “rebate dollars were overwhelmingly allocated to a minority of drugs,” with 10 percent of drugs accounting for 60 percent of rebate growth over the… (Zatorski, 9/13/19) #Medicare Part D, #Pharmacies, #Pharmacy Benefit Managers

Democratic Presidential Debate Highlights: Medicare for All and Gun Violence Addressed

Last night, the third 2020 Democratic Presidential primary debate took place in Houston, TX, featuring a narrowed 10-candidate stage. The majority of the first segment focused on Medicare for All and insurance reform, with solutions on gun violence being highlighted as well. Note that candidates qualified for the debate by garnering two percent of polling in at least four Democratic… (Slifer, 9/13/19) #Public Option, #Public Health, #Medicare for All

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