The CMS' move to allow Medicare Advantage plans to require patients to try low-cost generic drugs before more expensive therapies on Part B could lead to poor health outcomes, causing an increase in ED use and inpatient admissions, providers say.
The CMS is waiving an Obama-era guidance that prohibited Medicare Advantage plans from imposing prior authorization requirements on Part B drugs.
HHS revealed it has made progress reducing its Medicare appeals backlog and won't need to pursue the AHA's suggestions to expedite pending cases. But the agency conceded it won't be able to meet a federal judge's requirement to eliminate the backlog by the end of 2020.
Providers worry that the CMS, in its push to give patients greater access to both price and care information, may do more harm than good.
The CMS has not complied with a section of MACRA that requires it to impose prior authorization for chiropractic services, a government watchdog found. Chiropractors have one of the highest rates of improper payments in Medicare.
The CMS has finalized plans to give hospices nearly double the raise they received in 2018. The agency will also make it easier to check data on the troubled Hospice Compare website.
HHS will lower premiums for Medicare prescription drug plans next year, and the agency credited lower drug prices for the change.
Academic and rural hospitals will likely see a cut in Medicare funding if the CMS finalizes its proposal to reduce reimbursement for more-complex patients, according to Moody's Investors Service.
The CMS will give post-acute care providers more than $900 million in collective raises next year, including a 2.4% increase for skilled-nursing facilities and 1.3% for inpatient rehab centers.
During a congressional hearing, leaders from key medical societies accused the CMS of attempting to undermine Congress' work to help doctors move to value-based care as part of MACRA.
HHS Secretary Alex Azar promised a conservative audience that his agency would put out new guidance on the Stark law and HIPAA as well as overhaul Medicare billing structures to drive down government costs.
The CMS released its massive outpatient prospective payment rule, which included cutting payments for checkup visits as part of a new site-neutral payment policy. The move will save Medicare $610 million.