Archive for the Financial Feature Category

Senator Sanders Releases 2019 Medicare-for-All Bill 

Senator Bernie Sanders (I-VT) has released the 2019 version of his Medicare-for-All bill “to guarantee health care to every American as a right, not a privilege.” The Sanders’ legislation would fundamentally transform “the country’s dysfunctional health care system by eliminating profit-driven health insurance

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White House Releases FY 2020 Budget Proposal

President Trump recently submitted to Congress his budget request for fiscal year 2020. The budget request, which is not binding, proposes hundreds of billions of dollars in reductions to Medicare and Medicaid over 10 years.The budget request also contains a number of provisions related to drug pricing, opioids

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CMS Proposes to Lower Drug Costs by Targeting “Backdoor Rebates” and Encouraging Direct Discounts to Patients

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would amend the safe harbor regulation concerning discounts, which are defined as certain conduct that is protected from liability under the Federal anti-kickback statute, Section 1128B(b) of the Social

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Advance Notice of Methodological Changes for CY 2020 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2020 Draft Call Letter

CMS released proposed changes that “will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.” CMS released

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CMS Releases Notice of Benefit and Payment Parameters for 2020

The Centers for Medicare & Medicaid Services issued their proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year. The proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing

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CMS Final ACO Rule: Extensively Restructures the Program & Transfers More Risk

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule that will overhaul the Medicare Shared Savings Program, which is the program established by the Affordable Care Act (ACA) and launched in 2012 under which the vast majority of Medicare’s Accountable Care Organizations

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CMS Issues Proposed Rule to Lower Drug Costs

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would amend Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations “to support health and drug plans’ negotiation for lower drug prices and reduce

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Final Rule for CY 2019 Hospital Outpatient and ASC Prospective Payment Systems

The Centers for Medicare and Medicaid Services (CMS) have issued a rule that updates payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and in ambulatory surgical centers (ASCs) beginning Jan. 1, 2019 (CY 2019). The

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CMS Finalizes CY 2019 Revisions to Physician Fee Schedule

CMS has issued a final rule that includes update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2019 (CY 2019). The 2019 physician fee schedule conversion factor is $36.04, which

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CMS Finalizes CY 2019 End-Stage Renal Disease PPS Update

CMS has issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for services furnished on or after Jan. 1, 2019 (CY 2019). This rule updates the acute kidney injury (AKI) dialysis payment rate for

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