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States Make Medicaid Changes That Facilitate Medicare Provider Bonuses

CMS will unveil additional state Medicaid delivery and payment reforms before the Obama administration leaves office, and some of those reforms will help doctors receive Medicare bonuses in two years, CMS Deputy Administrator and Medicaid Director Victoria Wachino said Wednesday (Oct. 26).

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Moving forward with the 21st Century Cures legislation in the lame duck session would be a “missed opportunity” to recraft the bill next Congress to deal with drug pricing, argues a coalition of groups including labor unions and consumer and patient advocates in a letter sent to House and Senate Democratic leadership and the ranking Democrats on two key committees Wednesday (Oct. 26).

Senate Judiciary Chair Charles Grassley (R-IA) plans to hold a hearing after the November elections to examine the reported settlement between the Justice Department and EpiPen manufacturer Mylan and CMS' authority to hold companies accountable for misclassifying their products.

The Senate Finance Committee will update lobbyists Thursday (Oct. 27) on the status of the chronic care reforms that staff from both sides of the aisle are considering, according to an email Finance sent to its chronic care listserv.

The American Health Care Association is pushing a federal district court to keep CMS from enforcing a newly promulgated provision that prohibits pre-dispute binding arbitration agreements, and the nursing home lobby group expects the court to reach a decision by early November.

The Medicare Advantage star rating system needs new quality measures now that more than 70 percent of plans have achieved a rating of at least four out of five stars, CMS Deputy Administrator and Chief Medical Officer Patrick Conway said Tuesday (Oct. 25).

The administration Monday (Oct. 24) asked a federal appeals court to reverse an earlier decision finding that the administration violated the constitution by allowing cost-sharing reductions to flow without a Congressional appropriation.

CMS expects to give doctors more opportunities to qualify for alternative pay model bonuses in the new physician pay system by re-opening applications for 2018 participation in the Comprehensive Primary Care Plus and the Next Generation accountable care organization demonstrations and by starting two-sided risk in the Oncology Care Model in 2017, earlier than planned.

Issuers and beneficiary advocates remain miles apart when it comes to their views on special enrollment periods (SEPs), with issuers urging CMS to immediately implement a broad pre-enrollment plan and advocates saying more data on the impact of SEPs is needed before CMS takes further action to restrict them.