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<< Older News  |  September 20, 2021

News

All News > Medicare

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October 14 Deadline: Medicare Part D Notice of Creditable (or Non-Creditable) Coverage
Fraser Trebilcock Link to more items from this source
[Guidance Overview]
Sept. 17, 2021

"With respect to group health plans including prescription coverage offered by an employer to any Medicare Part D eligible employees (whether or not retired) or to Medicare Part D Medicare-eligible spouses or dependents, the employer must provide those individuals with a Notice ... to advise them whether the drug plan's total gross value is at least as valuable as the standard Part D coverage. Medicare Part D notices must be provided to Medicare-eligible individuals prior to October 15th of each year (i.e., by October 14th)."

Tags: Health Plan Administration  •  Medicare

New Health Care Transparency Requirements: Recommendations for Optimizing Pricing Data to Reduce System Costs
Robert Wood Johnson Foundation Link to more items from this source
Sept. 15, 2021

"Researchers found that hospital price transparency rules could be strengthened to measure price variation, empower employers to make better purchasing decisions and enable more accurate oversight of insurers by: [1] Expanding the number of hospitals publishing pricing data by increasing the maximum penalty from $300 per day to $5,500 per day. [2] Requiring hospitals to present data uniformly, through a 'machine readable' template that complies with [CMS] regulations. [3] Asking hospitals to display their commercial and Medicare rates side-by-side."

Tags: Health Plan Costs  •  Medicare

House Democrats Reveal Health, Paid Leave Policies in Budget Package
Mercer Link to more items from this source
Sept. 13, 2021

"Draft bills to add new benefits to Medicare, create a government-run paid family and medical leave benefit for US workers, and boost penalties for mental health parity violations were unveiled ... by key House committees.... A major concern for employers is whether [any proposal to] let the government negotiate drug prices will extend those negotiated prices to private plans."

Tags: Health Plan Design  •  Health Plan Policy  •  Medicare  •  Prescription Drug Costs

Medicare Part D Notices Required Before October 15
Fisher Phillips Link to more items from this source
[Guidance Overview]
Sept. 7, 2021

"The Medicare Part D notice requirement is generally straightforward, but [there are still] questions every year regarding these notices.... [T]his guide [is designed to] help answer some of the most common employer inquiries."

Tags: Health Plan Administration  •  Medicare

Medicare's Hospital Fund Is Running Out of Money; Here Are Reforms That Could Help
FierceHealthcare Link to more items from this source
Sept. 2, 2021

"[1] Shifting who pays for home health services.... [2] Targeting record Medicare Advantage [MA] profits.... [3] Changing how MA payments are calculated.... [4] Changing provider reimbursements.... [5] Controlling high-cost drugs administered in hospitals."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

2021 Medicare Trustees Report (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Sept. 1, 2021

"The estimated depletion date for the [hospital insurance (HI)] trust fund is 2026, the same as in last year's report. As in past years, the Trustees have determined that the fund is not adequately financed over the next 10 years. HI income is projected to be lower than last year's estimates due to lower payroll taxes." [Also available: 2021 Expanded and Supplementary Tables and Figures (ZIP)]

Tags: Health Plan Costs  •  Medicare

Medicare Part A Funds to Run Out in 2026
Kiplinger Link to more items from this source
Sept. 1, 2021

"The trust fund for Medicare Part A will be able to pay full benefits until 2026 before reserves will be depleted. That's the same year as predicted in 2020 ... Reserves for the Hospital Insurance Trust Fund fell by $60 billion, to $134 billion, at the end of 2020. This drop was related to the expansion of the Medicare Accelerated and Advance Payments Program because of COVID-19."

Tags: Medicare

How Would Drug Price Negotiation Affect Medicare Part D Premiums?
Henry J. Kaiser Family Foundation Link to more items from this source
Aug. 13, 2021

"The debate over a budget reconciliation package in the coming weeks, and possibly months, is likely to focus heavily on the savings to Medicare, which can be used to expand Medicare benefits and fund other health care priorities. However, by lowering Medicare spending for Part D, which covers retail prescription drugs, drug price negotiation proposals would also be expected to lower premiums that beneficiaries pay for Part D coverage."

Tags: Medicare  •  Prescription Drug Costs

Court Applies Section 1557 Nondiscrimination Requirements to Insurer's Entire Operations
Thomson Reuters / EBIA Link to more items from this source
Aug. 12, 2021

"The court explained that Section 1557 prohibits discrimination under any health program or activity, 'any part of which' receives federal financial assistance and therefore, the plain text of the statute unambiguously prohibits discrimination by an insurer under its 'entire portfolio.' Pointing out that the insurer offered a Medicare plan that was receiving federal financial assistance, the court denied the insurer's request to dismiss the case, ruling that the insurer's acceptance of federal assistance under its Medicare plan meant that its entire portfolio must comply with Section 1557." [Fain v. Crouch, No. 20, 740 (S.D. W.Va. May 19, 2021)]

Tags: Health Plan Design  •  Medicare

Expanded Medicare Benefits in Democrats' Plan Include Dental, Hearing and Vision
National Public Radio [NPR] Link to more items from this source
Aug. 10, 2021

"Senate Majority Leader Chuck Schumer released an outline of a coming budget bill that includes a directive to the Senate Finance Committee to expand Medicare 'to include dental, vision, hearing benefits.' ... [A]ll the Democrats in the Senate and almost all in the House will have to agree on the entire budget bill for Schumer's proposal to become law."

Tags: Health Plan Design  •  Medicare

CMS Proposes Pulling Model That Ties Part B Drug Prices to Those Paid Overseas
FierceHealthcare Link to more items from this source
Aug. 9, 2021

"The Biden administration has pulled a Trump-era regulation that ties Medicare Part B prices for certain products to prices paid overseas. The proposed rule released [August 6 by CMS] comes in response to a series of legal defeats that the Biden administration faced over the controversial model."

Tags: Medicare  •  Prescription Drug Costs

Medicare Part D Notices Must Be Provided by October 15
HUB International Link to more items from this source
[Guidance Overview]
Aug. 6, 2021

"Only individuals eligible for Medicare Part D have to receive the notice. However, most employers send the notice to all participants since they may not always know if someone is eligible for Part D (for example, a dependent who may be eligible because of disability)."

Tags: Health Plan Administration  •  Medicare

CMS: Part D Premiums Projected to Increase Nearly 5% in 2022
FierceHealthcare Link to more items from this source
July 30, 2021

"The average Part D premium is projected to increase by nearly 5% from $31.47 to $33 in 2022.... The announcement comes amid several potential major changes to Medicare being debated in Congress."

Tags: Medicare  •  Prescription Drug Costs

CMS Proposes Expansion of Telehealth Coverage
Sheppard Mullin Link to more items from this source
July 28, 2021

"This temporary extension of Medicare covered telehealth services will also see additional services added to the coverage list, allowing more data to be collected on the efficacy of these services. CMS has noted however, that it does not intend to permanently add these proposals as they do not meet the criteria for Medicare coverage that are currently on the books."

Tags: Medicare  •  Teleheath

Medicare Proposes New Changes for Telehealth Services in 2022
Foley & Lardner LLP Link to more items from this source
[Guidance Overview]
July 23, 2021

"This article discusses: [1] the current state of Medicare telehealth services; [2] requests for new telehealth services; [3] extending the timeframe for Category 3 temporary codes; [4] a new permanent code for virtual check-ins longer than 10 minutes; and [5] whether CMS should continue allowing direct supervision via telemedicine."

Tags: Medicare  •  Teleheath

CMS to Permanently Cover Audio-Only Telemedicine for Mental Health
Foley & Lardner LLP Link to more items from this source
July 21, 2021

"CMS has historically been reluctant to cover audio-only technology out of concern it could lead to inappropriate overutilization of services and concern that audio-video visualization is necessary to fulfill the full scope of service elements of CPT codes. Yet, given the widespread use of audio-only services during the PHE, CMS reconsidered its position and altered its policy to respond to changing patient needs and evolving clinical practices."

Tags: Health Plan Design  •  Medicare  •  Teleheath

New Alzheimer's Drug Clouds Outlook for Medicare Premiums Next Year
Reuters Link to more items from this source
July 12, 2021

"Aduhelm will be administered by healthcare providers, and thus will be covered under Part B, rather than the Part D prescription drug program. And the impact on Part B finances could be huge. The premium paid by enrollees -- which covers 25% of program costs -- could rise sharply. So could the remainder of Part B costs, which are covered by all taxpayers."

Tags: Health Plan Costs  •  Medicare

Billions for Controversial Alzheimer's Drug Could Buy This Instead
Kaiser Health News Link to more items from this source
[Opinion]
July 6, 2021

"Make Medicare more affordable.... Pay for vision, hearing and dental care.... Support family caregivers.... Strengthen long-term care.... Help people age in place.... Find out what older adults need.... Focus on prevention.... Invest in social determinants of health."

Tags: Health Plan Costs  •  Medicare

Hospital Groups Raise Red Flags About Spending Offsets in Bipartisan Infrastructure Bill
Healthcare Financial Management Association [HFMA] Link to more items from this source
June 30, 2021

"The bill would be paid for in part by adding to the time frame for the 2% reduction in Medicare payments. That decrease, known as sequestration, has been deferred during the COVID-19 public health emergency but is scheduled to be reinstated in 2022. Under the new bill, it would be extended through 2031 instead of 2030."

Tags: Health Plan Costs  •  Medicare

As Congressional Democrats Weigh Reconciliation Package, Voters Mostly Back Potential Health Measures
Morning Consult Link to more items from this source
June 30, 2021

"Eighty-four percent of voters are in favor of adding dental, vision and hearing coverage to Medicare ... 54 percent of voters ... back an effort to make premium subsidies for health insurance bought through the [ACA] marketplaces permanent."

Tags: Health Plan Design  •  Health Plan Policy  •  Medicare

FDA's Approval of New Alzheimer's Drug Has Multibillion Dollar Implications for Medicare
Henry J. Kaiser Family Foundation Link to more items from this source
June 29, 2021

"In 2017, nearly 2 million Medicare beneficiaries used one or more of the currently-available Alzheimer's treatments covered under Part D ... If just one-quarter of these beneficiaries are prescribed Aduhelm, or 500,000 beneficiaries, and Medicare pays 103% of $56,000 in the near term, total spending for Aduhelm in one year alone would be nearly $29 billion ... [T]otal Medicare spending for all Part B drugs was $37 billion in 2019."

Tags: Medicare  •  Prescription Drug Costs

Appellate Court Affirms Reinstatement of Retiree Medical Benefits for Rehired Employees
Thomson Reuters / EBIA Link to more items from this source
June 24, 2021

"The appellate court [concluded] that the state's retiree medical plan did not illegally discriminate against the officers on the basis of Medicare eligibility because they were not covered under that plan by virtue of their current employment status.... Finding the [Medicare secondary payer] rules inapplicable, the court concluded that the state violated its obligation under state law not to reduce or impair the officers' retirement benefits." [River City Fraternal Order of Police Lodge 614, Inc. v. Kentucky Retirement Systems, Nos. 20-5773, 20-5778 (6th Cir. Jun. 8, 2021)]

Tags: Medicare  •  Retiree Health Plans  •  State and Local Government Plans

Health Insurance Trends, May 2021 (PDF)
eHealth Link to more items from this source
May 27, 2021

29 presentation slides. "52% of insurers say they do not anticipate raising rates due to the COVID pandemic ... 33% are likely to make changes to plan benefits as a result of the pandemic ... 55% report a 50% or greater increase in utilization of telehealth benefits over the period before the pandemic."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare  •  Teleheath

OIG Report: Anthem Coding Errors Resulted in CMS Overpayments of $3.47 Million
Office of Inspector General [OIG], U.S. Department of Health and Human Services [HHS] Link to more items from this source
May 26, 2021

"For 123 of the 203 enrollee-years, the diagnosis codes that Anthem submitted to CMS were not supported in the medical records and resulted in $354,016 of net overpayments for the 203 enrollee-years.... On the basis of our sample results, we estimated that Anthem received at least $3.47 million of net overpayments for these high-risk diagnosis codes in 2015 and 2016."

Tags: Health Plan Costs  •  Medicare

Senate Finance Committee Considers Telehealth Expansion; Payment Approaches Are Key Talking Point
Healthcare Financial Management Association [HFMA] Link to more items from this source
May 21, 2021

"During a congressional hearing, a healthcare policy expert said fee-for-service is not a viable way to fund a Medicare telehealth expansion. Implementation of capitated payment models for telehealth is essential both to manage overall spending and to promote innovation, experts said. Pending legislation would permanently incorporate some of the telehealth waivers that were established in response to the public health emergency."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare  •  Teleheath


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