The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a toolkit to help Medicare Advantage (MA) organizations identify and evaluate high-risk diagnosis codes to ensure proper payments and provide better care for enrollees. The toolkit will help MA organizations use OIG’s techniques to improve the accuracy of their submitted diagnoses that are at high… (McClurg, December 15, 2023) #Medicare Advantage, #Program Integrity

The House Energy and Commerce (E&C) Committee convened a hearing to examine how federal agencies can leverage sector-specific expertise to navigate the evolving landscape of artificial intelligence (AI). Members discussed with Administration officials AI’s diverse applications across the health care, energy, and communications industries, weighing the advantages and potential risks associated with AI adoption, such as safety, security, bias, and… (Colocho, December 15, 2023) #Health Information Technology, #Hospitals, #Physicians, #Privacy, #Transparency

The Centers for Medicare and Medicaid Services (CMS) released revised guidance (Part B Guidance and Part D Guidance) for the Medicare Prescription Drug Inflation Rebate Program (press release, fact sheet). Overall, CMS provides clarity on the identification of rebatable drugs, as well as units to include in the calculation of inflation rebate amounts. The agency also addresses how rebates will… (Slifer, December 14, 2023) #Drug Pricing, #Medicare Part D, #Prescription Drugs

The Center for Medicare and Medicaid Innovation (CMMI or Innovation Center) recently released a blog post detailing several forthcoming changes to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2025.   The Innovation Center explains that the VBID model has grown exponentially since it began in 2017, from 9 to 69 participating Medicare Advantage Organizations (MAOs), and notes that much of… (Testa, December 14, 2023) #Demonstration Programs, #Dual Eligibles, #Health Equity, #Medicare Advantage, #Social Determinants of Health, #Special Needs Plans, #Value-Based Insurance Design

Today, the House of Representatives passed the Support for Patients and Communities Reauthorization Act by a vote of 387-37. The legislation features the reauthorization of many existing programs and the following new provisions: Requires future regulations addressing opioid use to include any opioid overdose reversal agent approved by the FDA. Increases flexibility for States to use State and Tribal response… (Marceno, December 12, 2023) #Mental and Behavioral Health, #Opioids, #Public Health

The Senate Health, Education, Labor & Pensions (HELP) Committee convened a markup of four bipartisan bills on addressing substance use disorder, early detection in cancer screening, and high-quality educational research. This included reauthorizing major provisions of the SUPPORT Act which expired at the end of September. Members of both parties were largely united in advancing all legislation before the Committee… (Marceno, December 12, 2023) #Opioids, #Prevention, #Public Health, #Women’s Health, #Workforce

The House of Representatives passed the Lower Costs, More Transparency Act by a vote of 320-71. The legislation features the following provisions: Increasing transparency of hospital prices, clinical diagnostic laboratory test prices, imaging prices, ambulatory surgical center prices, health coverage prices, and pharmacy benefit manager (PBM) practices; Parity in Medicare payments for hospital outpatient department services furnished off-campus; Prohibiting spread… (Slifer, December 12, 2023) #Clinical Labs, #Community Health Centers, #Disproportionate Share Hospitals (DSH), #Graduate Medical Education (GME), #Hospitals, #Pharmacy Benefit Managers, #Transparency

The Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report on competition in prescription drug markets from 2017 to 2022. ASPE notes that President Biden’s Executive Order on Promoting Competition in the American Economy identified a lack of competition as a key driver for problems across the economic sector. This… (McClurg, December 11, 2023) #Drug Pricing, #Generic Drugs

On December 7-8, the Medicare Payment Advisory Commission (MedPAC) held a public meeting at which it considered a series of draft payment update recommendations to Medicare payment systems in 2025 for inclusion in its March 2024 Report to Congress.   The Commission expressed support for 2025 draft payment recommendations to increase payments to acute care hospitals and providers and to… (Llamas, Testa, Marceno, McClurg, December 8, 2023) #Hospitals, #Physicians, #Post-Acute Care, #Skilled Nursing Facilities

The Centers for Medicare & Medicaid Services (CMS) reported that as of earlier this week, nearly 7.3 million individuals have enrolled in health insurance through the Marketplaces since open enrollment began on November 1, 2023. Highlights are as follows: 5 million individuals have enrolled in plans through the nationwide platform, HealthCare.gov; 775k individuals have enrolled through State-based Marketplaces in 18 states and D.C.;… (Joyce, December 8, 2023) #Affordable Care Act, #Health Insurance Exchanges