Medicare Archives - Page 3 of 11 - EMPLOYEE BENEFITS BLOG

Manchin Agrees to Expanded Reconciliation Deal

by McDermott Will & Emery | Aug 5, 2022 | Employee Benefits, Health and Welfare Plans

Senators Schumer and Manchin announce a bill that includes drug pricing and an extension of the advance premium tax credits, the amount individuals pay for monthly health insurance premiums when they buy health insurance on the Marketplace.

On July 27, 2022, Senate Majority Leader Schumer and Senator Manchin announced a surprise agreement to move forward with an expanded reconciliation bill titled the Inflation Reduction Act (summary here). The tentative deal includes drug pricing and expands upon a previous “healthcare-only” version of the reconciliation package that focused solely on drug pricing and a two-year extension of the advance premium tax credits (APTCs). The deal would raise an estimated $739 billion, with revenues going toward climate and healthcare initiatives, as well as reducing the federal deficit.

Leader Schumer and Senator Manchin released a joint statement outlining the agreement, which contains two key healthcare policy items: allowing Medicare to negotiate prescription drug prices and a three-year extension of APTCs. The three-year extension is one year longer than had been widely expected and reported in the previous version of the bill. The Biden-Harris Administration has also announced support for the bill. The package must go before the Senate Parliamentarian for Byrd Rule challenges before it can go to the Senate floor. It is expected to garner the Democratic support necessary to pass both the House and the Senate, and will move quickly from this point. The caveat to this is the impact of COVID-19. Several senators are already out, and Senator Dick Durbin (D-IL) announced July 28 that he has COVID-19 as well.

Read more here.

Biden Administration Takes Action to Improve Competition, Transparency and Quality for Hospitals and Nursing Homes

by Caroline Reignley, George Tzanetakos, Evie Atwater and Gregory Fosheim | Jul 14, 2022 | Employee Benefits, Health and Welfare Plans

The Centers for Medicare & Medicaid Services (CMS) recently published detailed databases summarizing changes of ownership of Medicare-enrolled hospitals and skilled nursing facilities (SNFs). The databases currently include information from 2016 to 2022, but the data will be updated and released quarterly. CMS also released the skilled nursing facility prospective payment system (SNF PPS) proposed rule (the Proposed Rule), including proposed updates to payment based on quality and value-based care measures.

Read more here.

HHS Supreme Court Loss Previews Low-Income Drug Discount Fight

by Emily J. Cook | Jul 12, 2022 | Benefit Controversies, Employee Benefits, Health and Welfare Plans

A recent US Department of Health and Human Services (HHS) US Supreme Court loss involving drug reimbursements to hospitals may impact a larger battle over drug discounts for low-income Americans. According to this Blomberg Law article, the Court ruled in June that HHS improperly cut $1 billion a year in drug reimbursements to hospitals through a government program that assists at-need populations. Now, both HHS and hospitals may be on the same side of a different skirmish—whether the agency can require pharmaceutical companies to offer discounts to specific pharmacies. McDermott Partner Emily Jane Cook said language in the Court’s opinion “suggests that the court does have a very favorable view of the 340B program and the hospitals that participate in that program.”

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Healthcare Enforcement in the Post-Pandemic Era

by Laura McLane, Tony Maida and Dana McSherry | Jun 28, 2022 | Digital Health, Employee Benefits, Health and Welfare Plans

As the world emerges from the COVID-19 pandemic, healthcare fraud enforcement remains a top priority for the US Department of Justice (DOJ) and other government agencies with enforcement authority. In this Westlaw Today article, McDermott Partners Laura McLane, Tony Maida and Dana M. McSherry describe some of the areas that have assumed particularly high enforcement priority, including private equity, telehealth and pandemic relief funds.

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See What’s Next with McDermott+Consulting’s 340B Ligitation Tracking Tool

by Emily J. Cook and Rodney Whitlock | Jun 17, 2022 | Employee Benefits, Health and Welfare Plans

The 340B program landscape is constantly shifting. Wednesday’s US Supreme Court American Hospital Association v. Becerra decision is of critical importance to hospitals that participate in the 340B program. The Court held that the US Department of Health and Human Services (HHS) improperly imposed a payment cut of almost 30% on 340B drugs paid by Medicare. Yet, while this decision is significant, it is not the end of the litigation surrounding the payment cut. The case has been remanded for further deliberation, which will include a determination of the remedies.

McDermott+Consulting has launched the 340B Litigation Tracking Tool, an up-to-date resource following the 30+ state and federal 340B program legal challenges. No more searching online or sorting through your newsfeed for updates on important case developments. This tracker, available 24/7 and routinely monitored by our team, delivers concise updates to help you make informed risk analyses on what’s next for your business in the evolving 340B landscape.

View the 340B litigation tracking tool here.

Biden Administration Foreshadows Impending Nursing Home Quality Reforms

by Evie Atwater, George Tzanetakos and Gregory Fosheim | Apr 7, 2022 | Benefit Controversies, Digital Health, Employee Benefits, Employment, Health and Welfare Plans, Labor

On February 28, 2022, the White House issued a fact sheet outlining several efforts aimed to increase safety, accountability, oversight and transparency in the senior services industry (Fact Sheet). Although the Fact Sheet’s initiatives have not yet been implemented, President Biden reiterated his administration’s focus on nursing home reform during his March 1, 2022, State of the Union address. Accordingly, the efforts described in the Fact Sheet provide stakeholders with a peek into the regulatory crystal ball of the governmental efforts that may be forthcoming, either through new laws, regulatory action, policy changes, enforcement activities or subregulatory guidance.

Read more here.

Trump-Era Medicare Program Under Increased Scrutiny

by Mara McDermott | Mar 17, 2022 | Digital Health, Employee Benefits, Health and Welfare Plans

A Trump administration-era Medicare program is under increased scrutiny from progressive Democrats. According to this Politico article, the program is a “direct contracting model” that allows private companies to participate in Medicare. Some Democrats, however, say the program is opening up a lane for Medicare privatization.

“There’s a dynamic with the left that [the Center for Medicare & Medicaid Innovation] [has] to deal with for sure,” said McDermott+Consulting’s Mara McDermott.

Access the article.

Saga and Legal Challenges Continue Despite Vaccine Requirement for Healthcare Workers

by Sandra M. DiVarco | Feb 23, 2022 | Employee Benefits, Employment, Health and Welfare Plans, Labor

The US Supreme Court’s January ruling allowing the Centers for Medicare & Medicaid Services to enforce its COVID-19 mandate is likely to continue to face challenges. Nevertheless, in this article published by the Health Care Compliance Association, McDermott Partner Sandra DiVarco said that the Supreme Court’s decision wasn’t a surprise.

“Many of [the CMS] providers may have slow-walked their compliance and now in theory need to be fully compliant,” DiVarco noted.

Access the article.

Broadband Internet a Hurdle as Telehealth Services Rise in Popularity

by Stephen Bernstein and Mara McDermott | Feb 1, 2022 | Digital Health, Employee Benefits, Health and Welfare Plans

Doctors and lawmakers say reliable broadband internet is lagging for populations that could benefit the most from telehealth services. In this MetroWest Daily News article, McDermott Partner Stephen Bernstein and McDermott+Consulting Vice President Mara McDermott offer insight into the challenges—and opportunities—for virtual care as it gains popularity.

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Staying Connected: An Update on Medicare Reimbursement for Telehealth Services After the PHE

by Amanda Enyeart, Dawn Helak, Marshall E. Jackson, Jr., Lisa Schmitz Mazur, Dale C. Van Demark, Mara McDermott and Lauren Knizner | Jan 11, 2022 | Employee Benefits, Health and Welfare Plans, Privacy and Data Security

In hopes that the COVID-19 public health emergency (PHE) will soon end, Congress and the administration are evaluating the telehealth expansions and flexibilities put in place to respond to the PHE. As a result, the future for telehealth stakeholders remains uncertain. This article outlines various changes in Medicare telehealth reimbursement policy in effect during the PHE and identifies what actions would be required to make these changes permanent.

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