Medicare began including telehealth as a benefit nearly 20 years ago, but has used it only on a limited basis. This was in large part because of statutory restrictions that limited coverage to rural beneficiaries who received care by certain practitioners in designated sites, which did not include the beneficiary’s home. Now, in the wake of the COVID-19 outbreak, policymakers are looking to telehealth as critical to ensuring that Medicare beneficiaries can still access care while reducing the risk of coronavirus transmission....

The Department of Health and Human Services (HHS) defines the social determinants of health as the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The concept, which comes from the global public health field, is at its best when it is understood to encompass an individual’s social location—their race, ethnicity, sex, class, ability, orientation, culture, and how each of these identities impact them in their community context. It was created to identify and serve the most vulnerable among the world’s populations and to address the inequities that disproportionately impact their lives and their health. ...

While conventional wisdom, and some presidential candidates, have already begun to temper these expectations, my goal here is to document five reasons why Medicare for All (M4All), Medicare buy-in, or federal public option legislation cannot pass in the near future. My hope, in doing so, is that we Democrats spare ourselves the precious time, internal acrimony, and political fallout that Republicans faced when their lofty ACA repeal promises went unfulfilled....

Last week, the Centers for Medicare & Medicaid Services (CMS) released Part II of its Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies for Calendar Year (CY) 2021 (fact sheet). The agency also released its proposed rule on policy and technical changes to MA and Part D for CYs 2021 and 2022 (fact sheet). A press release for both developments is available here. This post focuses on summarizing the Advance Notice component of this package of policies....

As the impeachment trial has concluded with the acquittal of President Trump, Congress is now returning to some sense of normalcy. On the health care front, policymakers will need to secure a deal relatively quickly on top-priority issues like prescription drug pricing and surprise medical billing. The apparent deadline for final legislation in both regards is the May 22 expiration date of funding for several public health programs (e.g., community health centers), which many are eyeing as the last real opportunity for meaningful reform this year. Many doubt whether Congress will produce much after that date because of compressed schedules to accommodate party conventions and an extended recess in October. However, health care is in the forefront of voters’ minds. ...

As Congress grapples with an evolving impeachment inquiry, lawmakers have remained focused on lowering prescription drug costs. In December, the House passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) by a 230–192 vote, largely along party lines with no Democratic defections. House Democratic leaders successfully assuaged grumblings from the Congressional Progressive Caucus that H.R. 3 did not go far enough by doubling the minimum number of drugs subject to price negotiation, among other policy changes....

Reaching a consensus on how to protect patients from surprise medical bills has eluded Congress for most of the year even though members in both parties and chambers are highly motivated to find a fix. With an agreement reached over the December 7–8, 2019, weekend, a solution seems closer than it has in a long time....

On November 15, 2019, The Centers for Medicare & Medicaid Services (CMS) finalized a controversial set of requirements for the disclosure of hospital pricing data to degrees heretofore not seen. Stemming from the recent transparency Executive Order (EO), the final rule reflects the current administration’s overall push to increase pricing and cost transparency throughout the health care system. While the original proposal faced substantial backlash from stakeholders, CMS’ final decision is nearly identical to what the agency originally proposed....

The following tables compare H.R. 3 based on the legislative text advanced by key committees of jurisdiction and key provisions of related proposals: the Prescription Drug Pricing Reduction Act of 2019 (S. 2543), advanced by the Senate Finance Committee in July; and the Advanced Notice of Proposed Rulemaking (ANPRM): Medicare Program, IPI Model for Medicare Part B Drugs, issued by the Centers for Medicare and Medicaid Services last October....

On Wednesday, October 9, the Department of Health and Human Services (HHS) announced highly anticipated proposed reforms to current regulations implementing the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute (AKS). Also addressed were related civil monetary penalties (CMPs) for inducements to beneficiaries to utilize services. HHS identified the regulations as they stand now as potential impediments to value-based purchasing arrangements for providers and suppliers participating in federal health care programs, as well as in the commercial sector....