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<< Older News  |  September 25, 2020


All News > Medicare

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October 14 Is the Last Day to Provide Medicare Part D Notice of Creditable (or Non-Creditable) Coverage
Fraser Trebilcock Link to more items from this source
Sept. 23, 2020

"[E]mployers offering group health plans with prescription drug coverage are required to disclose to all Part D-eligible individuals who are enrolled in or were seeking to enroll in the group health plan coverage whether such coverage was 'actuarially equivalent,' i.e., creditable.... This notice is required to be provided to all Part D eligible persons, including active employees over age 65."

Tags: Health Plan Administration  •  Medicare

Nationwide Evaluation of Health Care Prices Paid by Private Health Plans
RAND Corporation Link to more items from this source
Sept. 18, 2020

"In 2018, across all hospital inpatient and outpatient services, employers and private insurers ... paid 247 percent of what Medicare would have paid for the same services at the same facilities.... Some states ... had relative prices under 200 percent of Medicare; others ... had relative prices that approached 350 percent of Medicare.... High-value hospitals -- those offering low prices and high safety -- do exist."

Tags: Health Plan Costs  •  Medicare

International Reference Pricing for Medicare Drugs: New Lease on Life or Least Likely to Succeed?
Ropes & Gray LLP Link to more items from this source
Sept. 17, 2020

"[The Executive Order (EO)] provides no specifics for implementation, leaving it unlikely that any changes to the Medicare program contemplated by the EO will go into effect, if ever, before the 2020 election, by the end of the year, or soon thereafter. This Alert discusses the specifics of the EO, as well as some of the substantial challenges that will at least delay, and possibly prevent, its implementation."

Tags: Medicare  •  Prescription Drug Costs

Administration Again Takes Aim at Drug Prices
Arent Fox Link to more items from this source
Sept. 16, 2020

"The September Order now directs the Secretary of Health and Human Services (HHS) to implement two payment models, presumably via the Center for Medicare & Medicaid Innovation (CMMI), to address reimbursement for certain prescription drugs under both the Medicare Part B and Part D programs. However, the September Order does not provide much detail as to how the demonstrations will be operationalized."

Tags: Medicare  •  Prescription Drug Costs

Text of Presidential Executive Order: Lowering Drug Prices by Putting America First
The White House Link to more items from this source
[Official Guidance]
Sept. 14, 2020

"To the extent consistent with law, the Secretary of [HHS] shall immediately take appropriate steps to implement his rulemaking plan to test a payment model pursuant to which Medicare would pay, for certain high-cost prescription drugs and biological products covered by Medicare Part B, no more than the most-favored-nation price. The model would test whether, for patients who require pharmaceutical treatment, paying no more than the most-favored-nation price would mitigate poor clinical outcomes and increased expenditures associated with high drug costs."

Tags: Medicare  •  Prescription Drug Costs

President Trump Issues Expansive Order Aimed at Lowering Drug Prices
The New York Times; subscription may be required Link to more items from this source
Sept. 14, 2020

"The order covers all drugs paid for by Medicare -- including those sold at pharmacies -- and not just those administered in doctors' offices, as the president initially announced.... But it is unclear whether the White House has the authority to put the expansive order into effect. And in an odd twist, in calling for the secretary to set up the model programs, the administration is relying on its authority under the [ACA], which Mr. Trump and his fellow Republicans are trying to overturn in the Supreme Court."

Tags: Medicare  •  Prescription Drug Costs

New 'Care Compare' from CMS Empowers Patients when Making Important Health Care Decisions
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
Sept. 3, 2020

"Today, ... [CMS] launched Care Compare ... [which] provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data. With just one click, patients can find information that is easy to understand about doctors, hospitals, nursing homes, and other health care services instead of searching through multiple tools."

Tags: Health Plan Costs  •  Health Plan Information for Employees  •  Medicare

Telemedicine Gets Another Boost in Medicare Proposed 2021 Physician Fee Schedule
PwC Link to more items from this source
Aug. 31, 2020

"The proposed rule adds a third category of services, which would remain on the Medicare telehealth list through the end of the calendar year in which the COVID-19 PHE ends. Category 3 services have a potential likelihood of clinical benefit but have not yet shown sufficient clinical benefit to patients. Examples of category 3 services proposed include emergency department visits, psychological and neuropsychological testing, and home visits for established patients."

Tags: Coronavirus (COVID-19)  •  Health Plan Design  •  Medicare

Comparing Commercial and Medicare Professional Service Prices
Health Care Cost Institute [HCCI] Link to more items from this source
Aug. 31, 2020

"[F]rom 2014 to 2018, prices accounted for about 75 percent of the increase in spending above inflation.... [C]ommercial prices for professional services were, on average, 122% of Medicare rates nationally in 2017. Average commercial prices varied dramatically across states, from below Medicare rates in Alabama (98% of Medicare) to nearly twice Medicare rates in Wisconsin (188% of Medicare).... [T]he difference between commercial and Medicare prices was largest in northwestern states."

Tags: Health Plan Costs  •  Health Plan Design  •  Medicare

President Trump Orders HHS to Rescind Discount Safe Harbor for PBMs, But Questions Remain
Seyfarth Shaw LLP Link to more items from this source
Aug. 28, 2020

"Questions remain ... as to whether HHS has the legal authority to carry out the Order and, if it does, whether it can do so in a manner that will not increase costs. This article provides a background on the legal issues surrounding HHS's approach to the use of rebates by pharmaceutical manufacturers, then addresses the February 2019 proposed rule in light of the Order, and concludes with a discussion of future considerations."

Tags: Medicare  •  Prescription Drug Costs

Medicare Part D Notice Deadline is October 15
HUB International Link to more items from this source
[Guidance Overview]
Aug. 18, 2020

"There are potentially four situations where the notice must be provided.... [1] annually prior to the Part D annual enrollment period beginning October 15th.... [2] prior to an individual's enrollment in the employer's plan. Therefore, it should also be sent to new hires.... [3] if the employer's prescription drug benefit ever changes from 'Creditable' to 'Non-Creditable' (or the other way around), an updated notice must be provided as soon as possible, but no later than 30 days from the change.... [and] [4] on request. [It can] be sent electronically ... if the employer meets the ERISA rules for electronic delivery."

Tags: Health Plan Administration  •  Medicare

Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Guidance Overview]
Aug. 4, 2020

"[CMS] is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed [August 3]. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas."

Tags: Coronavirus (COVID-19)  •  Health Plan Design  •  Medicare

D.C. Court of Appeals Opinion Upholding HHS Cuts to Medicare Drug Reimbursement Rates (PDF)
U.S. Court of Appeals for the District of Columbia Circuit Link to more items from this source
Aug. 3, 2020

42 pages. "[HHS] reduced the reimbursement rate for covered drugs by 28.5% ... for 340B hospitals because they can obtain drugs far more cheaply than other hospitals.... Several hospitals and hospital associations challenge HHS's decision, claiming that it rests on an impermissible construction of the governing statute.... We hold that HHS's decision to lower drug reimbursement rates for 340B hospitals rests on a reasonable interpretation of the Medicare statute." [American Hospital Ass'n v. Azar, No. 19-5048 (D.C. Cir. Jul. 31, 2020)]

Tags: Medicare  •  Prescription Drug Costs

HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization Amid COVID-19
U.S. Department of Health and Human Services [HHS] Link to more items from this source
July 29, 2020

"[T]elehealth adoption increased by nearly 50 percent in primary care at the peak ... While the report did not analyze specialist visits, other studies mentioned in the report have also shown dramatic increases in telehealth use during the pandemic among specialists such as psychiatry, gastroenterology and neurology[.]"

Tags: Health Plan Design  •  Medicare

Medicare Beneficiary Use of Telehealth Visits: Early Data from the Start of the COVID-19 Pandemic
Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS] Link to more items from this source
July 29, 2020

"This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the [public health emergency (PHE)].... The analysis found Medicare primary care visits dropped precipitously from mid-March at the start of the pandemic, at the same telehealth visits increased for primary care. Nearly half of Medicare primary care visits were provided via telehealth in April, compared with less than one percent before the PHE in February."

Tags: Health Plan Design  •  Medicare

Editor's Pick President Trump Signs Drug Pricing Executive Orders Reinforcing the Administration's Priorities
K&L Gates Link to more items from this source
[Guidance Overview]
July 28, 2020

"Although the drug pricing executive orders are unlikely to be implemented before the 2020 election, they reinforce the administration's priorities on drug pricing. As stakeholders plan for the years ahead, they should be mindful of their potential impact on their operations. This [article] provides an overview of the President's drug pricing executive orders and describes their scope and potential impact."

Tags: Medicare  •  Prescription Drug Costs

D.C. Circuit Court Affirms Judgment That Struck Down Rule Mandating Price Disclosure in Pharmaceutical Ads
Holland & Knight Link to more items from this source
July 3, 2020

"The court of appeals largely focused on the scope of rulemaking authority that is granted by statutory language authorizing the promulgation of rules for 'administration' of a federal program.... Although the court closed with the caveat that 'nothing in this opinion holds that the Secretary is categorically foreclosed from regulating pharmaceutical advertisements,' it left little doubt that compelled price disclosure of the type required by the rule was beyond the agencies' authority[.]" [Merck & Co. v. HHS, No. 19-5222 (D.C. Cir. Jun. 16, 2020)]

Tags: Medicare  •  Prescription Drug Costs

Editor's Pick How COBRA and Medicare Interact for Retirees
ABD Insurance & Financial Services Link to more items from this source
[Guidance Overview]
June 16, 2020

"There are four primary issues for Medicare-eligible employees to consider upon deciding if and when to elect COBRA after terminating employment.... [1] Medicare will pay primary ... [2] The eight-month Medicare Special Enrollment Period is not extended by COBRA enrollment ... [3] COBRA does not qualify to avoid Part B late enrollment penalties ... [4] Early termination of COBRA upon enrollment in Medicare."

Tags: COBRA  •  Medicare

COVID-19 and the Impact on Telehealth Services
ORBA Link to more items from this source
June 3, 2020

"Recent [Medicare] policy changes have temporarily relaxed restrictions on where and by whom telehealth services can be provided, making them much more accessible during the current public health emergency.... Waiver of originating site requirement ... New or existing patients ... Expanded list of services and providers ... Audio vs. video."

Tags: Coronavirus (COVID-19)  •  Health Plan Design  •  Medicare

Retiree Health Cost Estimates for 2020
Milliman's Healthcare Town Hall Link to more items from this source
May 29, 2020

"A healthy 65-year-old couple retiring in 2020 is projected to spend approximately $351,000 in today's dollars ($535,000 in future dollars) on healthcare over their lifetime. Expenses at age 85 are estimated to be 234% higher than that at age 65.... A healthy 45-year-old couple is projected to spend approximately $505,000 in today's dollars ($1.4 million in future dollars) on healthcare over their lifetime."

Tags: Health Plan Costs  •  Medicare  •  Retiree Health Plans

CMS Proposes Steep Penalties for Medicare Secondary Payer Noncompliance
Hall Benefits Law Link to more items from this source
May 27, 2020

"The proposed rule provides for the following civil monetary penalties for noncompliance: [1] Group health plans: $1,000 per day per person, up to a maximum penalty of $365,000 (adjusted over time for inflation). [2] Non-group health plans: the per-day penalty is discretionary but would be capped at $1,000 per day per person, up to a maximum penalty of $365,000 (adjusted over time for inflation)."

Tags: Health Plan Design  •  Medicare

DOL Releases New Model COBRA Notices Amid Continued Wave of Litigation
Littler Link to more items from this source
[Guidance Overview]
May 6, 2020

"The new general notice and election notice are nearly identical to their prior versions, with the exception of new sections explaining how Medicare eligibility affects COBRA participants. In particular, the new language outlines the Medicare election obligations and how these rules impact Medicare-eligible employees who have just lost their employer-sponsored active employee coverage. The new language also highlights that COBRA coverage usually pays secondary to Medicare[.]"

Tags: COBRA  •  Medicare

EBSA Issues New COBRA Model Notices for Employee Benefit Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
May 1, 2020

"[EBSA] today issued Frequently Asked Questions ... and revised COBRA model notices [Model general notice and Model election notice].... 'The information we're providing today will help Medicare-eligible Americans make key decisions regarding their healthcare coverage,' said U.S. Secretary of Labor Eugene Scalia. 'As many individuals face economic hardship related to coronavirus, the Department will continue to inform workers and help them avoid incurring unnecessary health costs.' Scalia added[.]"

Tags: COBRA  •  Medicare

2020 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
Apr. 24, 2020

255 pages. "Medicare's costs under current law rise steadily from their current level of 3.7 percent of GDP in 2019 to 6.0 percent in 2044. Costs then continue to grow, but at a slower rate, until reaching 6.5 percent in 2094. Under the illustrative alternative, projected costs would continue rising steadily throughout the projection period, reaching 6.3 percent of GDP in 2044 and 8.5 percent in 2094."

Tags: Health Plan Costs  •  Medicare

Medicare Finances: Findings of the 2020 Trustees Report (PDF)
National Academy of Social Insurance [NASI] Link to more items from this source
Apr. 24, 2020

10 pages. "According to the 2020 Medicare Trustees Report, expenditures from Medicare's HI Trust Fund exceeded revenues by $5.8 billion in 2019. Without a policy change aimed at increasing revenues or reducing expenditures, the surplus that has accumulated in the HI Trust Fund over the years will be depleted by 2026. The HI Trust Fund will have to rely on the annual revenue from Medicare payroll taxes and to a lesser extent its other sources of income, which together are projected to cover 90 percent of annual expenditures in 2026."

Tags: Health Plan Costs  •  Medicare

<< Older News  |  September 25, 2020

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