The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) conducted an audit to assess whether Medicaid State agencies were properly invoicing for and collecting rebates for physician-administered drugs under the Medicaid drug rebate program. Enacted in 1991, the Medicaid drug rebate program mandates manufacturers to provide rebates to States for covered outpatient drugs, ensuring eligibility… (Eisen, 1/1/70) #Drug Pricing, #Physicians

The House Ways & Means (W&M) Committee convened a markup of legislation to support rural health providers and access to telehealth. H.R. 8261 with telehealth and Hospital at Home extensions received broad bipartisan support, but every bill and amendment other than the telehealth extension had a party line vote. Republicans passed several pieces of legislation targeted to rural health providers… (McClurg, May 9, 2024) #Graduate Medical Education (GME), #Hospitals, #Rural Health, #Telehealth

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a report examining California’s Medicaid eligibility procedures during the unwinding period following the end of the continuous enrollment condition due to the COVID-19 pandemic. This audit, prompted by legislative changes including the Families First Coronavirus Response Act (FFCRA) and the Consolidated Appropriations Act, 2023 (CAA),… (Eisen, May 9, 2024) #Coverage Decisions, #COVID-19, #Insurance Coverage

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) Innovation Center, announced the Increasing Organ Transplant Access (IOTA) Model (press release/ fact sheet/full proposal).  The IOTA Model aims to increase access to life-saving kidney transplants for patients living with kidney disease and reduce Medicare expenditures by transplanting more patients and removing… (Lewis, May 8, 2024) #Chronic Diseases, #Demonstration Programs, #End-Stage Renal Disease, #Hospitals

The Centers for Medicare and Medicaid Services (CMS) issued updates to the Master List of Items Potentially Subject to Face-To-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements (Master List) and the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List Background. The Master List is a library of Durable… (Slifer, May 10, 2024) #Coverage Decisions, #Medical Devices

Today the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) Innovation Center, announced the Increasing Organ Transplant Access (IOTA) Model (press release/ fact sheet/full proposal).  The IOTA Model aims to increase access to life-saving kidney transplants for patients living with kidney disease and reduce Medicare expenditures by transplanting more patients and… (Lewis, May 8, 2024) <span style="font-size:90%;

The Senate Budget Committee convened a hearing to examine ways to alleviate administrative burdens in health care. Democrats used the hearing to criticize prior authorization and emphasize the need for standardization across different insurance companies. Chairman Sheldon Whitehouse (D-RI) also took the opportunity to highlight his discussion draft with Sen. Bill Cassidy (R-LA) that includes provisions for hybrid payments for… (Marceno, May 8, 2024) #Costs, #Delivery Reform, #Insurance Coverage, #Insurance Reform

As the deadline to reauthorize Farm Bill Programs by the end of the fiscal year approaches, policymakers in the committees of jurisdiction have begun to discuss legislative proposals. In addition to agricultural programs, the Farm Bill authorizes several important federal nutrition programs including the Supplemental Nutrition Assistance Program (SNAP). The 2018 Farm Bill expired on September 30, 2023 but the programs… (McClurg, May 8, 2024) #Nutrition

The House Ways & Means Committee is convening a markup Wednesday May 8th at 10:30am to discuss legislative proposals aimed at temporarily extending certain pandemic-era flexibilities, including those related to telehealth (through 2026) and the Acute Hospital Care at Home initiative (through 2029). The cost of making telehealth flexibilities permanent is the primary factor driving consideration of a more modest… (Testa, May 7, 2024) #Hospitals, #Pharmacy Benefit Managers, #Rural Health, #Skilled Nursing Facilities, #Telehealth

Today, the Medicare Trustees released their latest report on the status of the Hospital Insurance (HI) and Supplemental Medicare Insurance (SMI) trust funds (fact sheet; press release). The Trustees release this report annually to provide an update on the projected financial status of the Medicare program. The report includes its finding from the last several years that Medicare faces long-term… (Testa, May 6, 2024) #Budget, #Costs, #Drug Pricing, #Hospitals, #Long-Term Care, #Medicare Advantage, #Medicare Part D, #Physicians, #Post-Acute Care, #Program Integrity