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Hospitals, Beneficiaries Press CMS To Address Rocky Transition To New QIOs

Hospitals complain that the transition to new Quality Improvement Organizations at the beginning of August has been problematic for both providers and beneficiaries, with both sides getting conflicting information from QIOs about appeals, having trouble reaching the QIOs and facing lost paperwork.

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CMS finalized a rule giving doctors and hospitals more time to adopt updated electronic health record technology and meet the second stage of the meaningful use program, although the agency announced Friday (Aug. 29) that it will not allow providers to show meaningful use of electronic health records for three months in 2015, as opposed to a full year, despite stakeholders' requests.

Industry lobbyists say they hear that CMS will announce, possibly soon after Labor Day, that it is delaying the dialysis star-rating system that has been the target of criticism from dialysis facilities, patients and even the Medicare Payment Advisory Commission.

Patient groups interested in spurring the development of new treatments should consider implementing a "venture philanthropy" model that could allow them to be more involved in innovative research, Cure Duchenne President Debra Miller told FDA Week.

Drug companies are pressing FDA to explain what its new "similar" category of biosimilars, which falls below the statutory "highly similar" measure, means for products that meet the lower bar, reacting to three new categories unveiled in FDA's draft biosimilar guidance on clinical pharmacology.

Individuals receiving advanced payment tax credits to offset the cost of their exchange plans will be responsible for repaying the government the full amount of those subsidies should they be found ineligible in coming days, Treasury tells Inside Health Policy, addressing an issue about which several beneficiary advocates said was unclear earlier this week.

CMS plans to again take the sunshine and health reform law's Open Payments system offline, announcing Thursday (Aug. 28) that the system will be unavailable due to scheduled maintenance for two days over the next two weeks, and two more days will be added to the end of the review and dispute process.

A federal District Court judge Wednesday (Aug. 27) rejected PhRMA's request that it throw out the Health Resources and Services Administration's new interpretive rule on 340B orphan drug exclusions, which is substantively identical to a rule the court vacated in May, but said the drug industry is free to file another lawsuit on the new rule.

CMS does not plan to waive restrictions on telemedicine services for accountable care organizations in the Medicare Shared Savings Program, an agency spokesman says, but it would consider doing so for pioneer ACOs separately participating in a demonstration.