Tag Archives: Kaiser Medicare News

House Panel Extends Funding For Medicare Program To Help Consumers

A House subcommittee voted on Thursday to continue $52 million in funding for a program that helps seniors understand the complexities of their Medicare coverage. Two weeks ago, a Senate committee voted to eliminate it.

The measure preserving the State Health Insurance Assistance Program, known as SHIP, is part of a massive spending bill for federal health, education and labor programs, approved by the Republican majority of the House appropriations  subcommittee that oversees those departments. Democrats opposed the bill, which would cut money for the Affordable Care Act, Medicare and the Social Security Administration. It would also bar the Centers for Disease Control and Prevention from research into gun violence.

“If the House had cut SHIP, we would have been in trouble, but the fact that funding levels are maintained gives us optimism,” said Howard Bedlin, vice president for public policy and advocacy at the National Council on Aging, a nonprofit service organization.

Earlier this week, 62 groups representing seniors’ and patient advocates, health care unions, elder law attorneys, social workers, visiting nurses and other organizations sent a letter to House leaders urging them to retain SHIP’s funding.

SHIP counselors in every state and the District of Columbia advised more than 7 million Medicare beneficiaries and their caregivers last year, answering questions about billing problems, drug plan options, appeals, subsidies and other issues. The California SHIP program, also known as the Health Insurance Counseling and Advocacy Program, received $5 million in federal support in 2015 and helped more than a half-million beneficiaries save $23.67 million, during the 12 months ending June 30, 2015. Ohio’s SHIP received federal funding of $1.84 million for the year ending March 31 and saved seniors $20.8 million in 2015.

The provision on SHIP was not discussed in the subcommittee’s deliberations Thursday. The House appropriations committee is expected to approve the spending bill next week. Eventually, after the full House of Representatives and the full Senate vote on their bills, negotiations will begin to reconcile differences.

After talking to congressional sources, Bedlin said he is confident the Senate Democrats will support the House proposal to maintain SHIP’s current funding. Only three months ago, Bedlin and other seniors’ advocates were trying to convince congressional leaders to increase support.

“Given the political realities, we now support maintaining current funding levels in the final House-Senate agreement,” he said.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Medicare, Syndicate

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Viewpoints: President Obama On Personalized Medicine; Medicare Advantage’s Growing Pains

USA Today:
Olympic Zika Fears Flip Out: Our View

When the Summer Olympics open in Brazil in less than a month, athletes and visitors will have plenty to contend with, from economic and political turmoil to polluted waters and a violent crime wave. The Zika virus — which has garnered the world’s attention, prompted several star athletes to skip the Olympics and stirred bitter debate over whether the Rio Games should go on — is far down on any realistic list of concerns. And if public health decisions are to be driven by facts, not fear, the decision to begin the Games on Aug. 5, as scheduled, is reasonable. (7/6)

Consumer Group: Many Lawmakers Opposing Medicare Change Got Drugmakers’ Contributions

Pharma Dollars Went Overwhelmingly To Lawmakers Opposing Medicare Part B Overhaul

After the Obama administration unveiled a proposal to overhaul Medicare Part B four months ago, a large number of lawmakers quickly and very vocally opposed the effort. Now, a new analysis finds that drug makers, who are worried the plan will cut into their revenue, have given them considerably more financial support than lawmakers who have not raised objections. Specifically, 310 lawmakers who either signed two letters opposing the overhaul or were critical of it received a total of more than $7.2 million from pharmaceutical and health products companies for their 2016 campaigns, according to the analysis by Public Citizen, the consumer advocacy group, which released its analysis on Monday. And the amount given to each representative averaged more than $23,300. (Silverman, 7/11)

Medicare Proposes Expansion Of Diabetes Prevention Program

The program, which has been tested in eight states, provides beneficiaries with coaching, lifestyle intervention and moderate physical activity. Also, on Capitol Hill, a House subcommittee approves a bill that would continue a program that aids beneficiaries.

Modern Healthcare:
CMS Proposes Expanding Diabetes-Prevention Model

In addition to a slew of changes to Medicare’s physician payment policies, the CMS on Thursday proposed expanding a program aimed at helping people avoid diabetes. The CMS suggests starting the program in 2018 and is seeking comment whether to launch the effort nationally or in additional select markets. (Dickson, 7/7)

Kaiser Health News:
House Panel Extends Funding For Medicare Program To Help Consumers

A House subcommittee voted on Thursday to continue $52 million in funding for a program that helps seniors understand the complexities of their Medicare coverage. Two weeks ago, a Senate committee voted to eliminate it. The measure preserving the State Health Insurance Assistance Program, known as SHIP, is part of a massive spending bill for federal health, education and labor programs. (Jaffe, 7/7)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Insurance Mega-Mergers Draw Concern From Federal, State Regulators

Aetna Said To Meet With DOJ On Friday About Humana Deal

Aetna Inc. is preparing to meet with top U.S. Justice Department officials on Friday as it seeks to win antitrust approval for its $37 billion takeover of rival Humana Inc., people familiar with the matter said.
The insurer plans to meet with antitrust officials, including the department’s No. 3, Bill Baer, one of the people said, a top-level gathering that signals the review is entering a final, make-or-break stage. (Tracer, McLaughlin and Hammond, 7/7)

Drugmakers And Patient, Doctors’ Groups Seem To Link Opposition To Medicare Payment Change

East Bay Times:
Big Pharma’s $70 Million Tops California Campaign Contributions

With Californians facing the busiest ballot in more than a decade, big spenders are poised to make it one of the most expensive election battles in state history — already contributing $185 million to fight over everything from sex, drugs and guns to tobacco and taxes. The money is piling up on behalf of campaigns for 17 statewide ballot measures — the most since March 2000. And when it comes to big backers, Big Pharma is far and away the towering force. (Seipel, 7/11)

Viewpoints: Time For A Change In Course For FDA?; A Key Moment For The Health Law’s Medicaid Expansion

The Wall Street Journal:
It’s Time To Radically Change How The FDA Approves Drugs

I’m a big fan of the U.S. Food and Drug Administration (FDA) and the vital mission it has been performing since 1962: ensuring that all medications sold in the United States are both safe and effective. Everyone should want the FDA to succeed — now and in the future — because, without a strong FDA, being sick would be massively more horrible than it already is. But, although a fan, I think the FDA should change course. Specifically, the FDA should adjudicate new drug applications with a Consumer Reports approach, not its current approach, which copies Roman emperors who signaled a gladiator’s fate with either a thumbs-up or thumbs-down, and no other choice. (John Sotos, 6/29)

17 Insurers, 200 Physician Groups To Join Medicare’s Cancer Project To Improve Care

Modern Healthcare:
Doctors, Insurers Flock To Medicare’s Cancer Payment Demo Despite Questions

Seventeen private health insurance companies and more than 3,200 oncologists working in almost 200 medical groups will participate in the federal government’s new cancer care project, but critics argue the program may not easily lower costs or reduce unnecessary and potentially harmful care. … The timing of the program’s rollout coincides with Vice President Joe Biden’s national push to cure cancer, as well as the Innovation Center’s controversial attempt to change how Medicare Part B pays for outpatient drugs, like those used for cancer patients. (Herman, 6/29)

Official Tells Hill Panel Medicare May Revise Controversial Drug Payment Proposal

The Associated Press:
Medicare Weighs Changes To Controversial Plan On Cancer Meds

Affected [by the proposal] are those medications administered in a doctor’s office. That includes most chemotherapy drugs, as well as injected and infused drugs for macular degeneration, rheumatoid arthritis, some immune diseases and other conditions. … Medicare now pays doctors and hospital outpatient clinics the average sales price of a drug, plus a 6 percent add-on. Since 6 percent of a $15,000 drug is more than 6 percent of a $3,000 drug, some experts believe the formula influences doctors’ prescribing decisions. The new formula would combine a 2.5 percent add-on with a flat fee for each day the drug is administered. A control group of doctors and hospitals would continue to be paid under the current system. (Alonso-Zaldivar, 6/28)

HHS Proposes To Streamline Medicare Appeals Process

The Department of Health and Human Services Tuesday proposed key changes in the Medicare appeals process to help reduce the backlog of more than 700,000 cases.

The measures “will help us get a leg up on this problem,” said Nancy Griswold, chief law judge of the Office of Medicare Hearings and Appeals.

If there was not a single additional appeal filed and no changes in the system, it would take 11 years to eliminate the backlog, Griswold said in an interview.

Her office has faced increased criticism from health care providers and beneficiary advocates lately for its inability to speed up appeals and reduce the backlog. The latest critique came earlier this month in an investigation from the Government Accountability Office.

This latest effort still falls short of what is needed, said Tom Nickels, executive vice president at the American Hospital Association. “We are deeply disappointed that HHS has not made more progress in addressing the delays despite the more than two years since the delays began,” he said.

The new proposals, as well as increased funding requests, are expected to eliminate the backlog by 2021 by streamlining the decision-making process and reducing the number of cases that go to the third level of appeals, where many cases linger waiting for a hearing and then a decision from an administrative law judge. From the day of the hearing, it currently takes an average of slightly more than two years for a decision in appeals from hospitals, nursing homes, medical device suppliers and other health care providers.

Among the proposed changes:

  • Designate some decisions from the Medicare Appeals Council, the last of four stages of appeals, as precedents that decision-makers at lower levels would have to follow. That could eliminate redundant appeals and resolve inconsistencies in interpretation of Medicare policies.
  • Allow senior attorneys to handle some of the procedural matters that come before the administrative law judges, such as dismissing a request for a hearing after the appellant has withdrawn the request, Griswold said.
  • Revise how the minimum amount necessary to lodge an appeal is determined. Under current rules, an appeal must involve payment of at least $150, based on the amount the provider charged. HHS is proposing to use Medicare’s allowed amount instead, which tends to be lower, and that could reduce the number of claims that could be appealed.
  • Eliminate some steps in the appeals process to simplify the system.

Although advocates have sought changes to speed up the appeal process, Alice Bers, an attorney at the Center for Medicare Advocacy, was skeptical about some of the proposals. The effort to set up a system of precedents, she said, “could restrict coverage for needed items and benefits for seniors that they are entitled to by law.”

And the change in calculating the minimal amounts “could make it harder for beneficiaries to reach that threshold,” said Bers. It might not sound like a lot of money, Bers said, “but for an elderly woman living on Social Security that’s several meals or co-pays for medicine.”

The proposals do not address what hospital representatives say is a key cause of increasing appeals, independent audit contractors who can reject payments to hospitals. The American Hospital Association contends that those contractors unnecessarily cut off many payments and that hospitals frequently win the appeals.

According to the GAO study, audit-related appeals decided at the administrative law judge stage — the third level of appeals — increased 37-fold from 2010 through 2014, compared to only 1.5 times for appeals of other kinds of claims.

But Griswold said that currently only about a third of the pending cases at this stage involved recovery audit contractors, after settlements were reached with hospitals who agreed to accept partial payment in return for withdrawing more than 220,000 cases.

Griswold also said Medicare will continue to process beneficiary appeals before those from hospitals, doctors and other health care providers. The practice began in 2014.

The proposed changes will be posted on the Federal Register website and open to comments through Aug. 29.

This story was corrected to add that the settlements with hospitals involved more than 220,000 cases.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

Categories: Aging, Cost and Quality, Health Industry, Medicare, Syndicate

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