October 29, 2019

White House Issues Executive Order on Medicare

On Thursday, October 3, President Trump issued an Executive Order on “Protecting and Improving Medicare for our Nation’s Seniors.”  While the Executive Order does not provide legislative or regulatory specifications, it raises policy areas that the President believes need to be addressed to improve the Medicare program. The Executive Order aims to expand enrollment in Medicare Advantage (MA) plans to make them more attractive to seniors than the traditional fee-for-service program.  Within one year, the Secretary of Health and Human Services is asked to propose regulations and implement other administrative actions to provide more diverse and affordable MA options for seniors, by: Encouraging innovative MA benefit structures and plan designs, including better use of Medical Savings Accounts (MSAs) by seniors; Including a […]
October 29, 2019

Health and Human Services Proposes Stark Law and Anti-Kickback Statute Reforms

On October 9, the Department of Health and Human Services (HHS) announced proposed changes to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the “Stark Law”) and the Federal Anti-Kickback Statute. The proposed rules seek to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposals would ease the compliance burden for healthcare providers across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse. The proposed rules are part of HHS’s “Regulatory Sprint to Coordinated Care,” which seeks to promote value-based care by examining federal regulations that impede efforts among providers to better coordinate care for patients. The Stark Law’s new value-based exceptions, […]
September 30, 2019

Congress Seeks Higher Payments for Non-Opioid Alternatives

The US Senate, in proposed legislation, advocated for greater reimbursement for device-based opioid alternatives. Language buried in the Senate’s fiscal 2020 Labor-HHS appropriations report, released Wednesday, directs CMS to boost Medicare reimbursement for device-based opioid alternatives. The appropriations legislation, which has been mired in a dispute between Republicans and Democrats over abortion policy and related funding for construction of the border wall, does not appear to have immediate support for passage. House Appropriations Committee Chairwoman Nita Lowey, D-N.Y., introduced a continuing resolution Wednesday, which Senate Appropriations Committee Vice Chairman Leahy, D-Vt., threw support behind, but the prospect of the proposal remains uncertain. In the Proposed Rule for the Hospital Outpatient Prospective Payment System, CMS’ indicated they did not intend to […]
September 30, 2019

GAO Indicates Medicare quality measures need improvement

Center for Medicaid and Medicare Services quality measures might not measure or capture the actual care patients receive, according to a new Government Accountability Office (GAO) report. The GAO studied how the agency decides what quality measures to develop and use. It also evaluated how CMS monitors its funding for quality measurement activities. The GAO report stated that CMS doesn’t have processes to ensure that the indicators actually measure what the agency says it cares about in its strategic objectives. The GAO also found that the CMS carries over large sums of unused funds each year for activities related to quality measurement and that the CMS fails to keep track of all its quality-measurement funding. The report recommends that CMS should create standard […]