Medicare and Medicaid


New Rule Requires Drug Price Disclosure in TV Ads
May 15, 2019 | Eric D. Fader | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals
On May 8, the U.S. Department of Health and Human Services announced a final rule from the Centers for Medicare & Medicaid Services requiring pharmaceutical companies to disclose the list prices of prescription drugs in television advertisements. The rule will apply to all drugs covered by Medicare or Medicaid that cost at least $35 per …
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Centene’s Proposed WellCare Acquisition May See DOJ Scrutiny
May 2, 2019 | Eric D. Fader | Antitrust | Fraud and Abuse | Medicare and Medicaid | Private Insurers
An April 30 article in Managed Care, “Centene, big in Medicaid managed care, wants to get even bigger,” discussed the business plans of Centene, the largest Medicaid managed care insurer in the U.S.  Rivkin Radler’s Christopher J. Kutner was quoted in the article. Centene is hoping that its proposed acquisition of WellCare Health Plans will …
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HHS Announces New Primary Care Pay Models
April 23, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
On April 22, U.S. Department of Health and Human Services (HHS) officials announced the introduction of five optional value-based care models for large and small primary care physician practices. The new payment models will incorporate incentives for keeping Medicare patients healthy, as alternatives to traditional fee-for-service payment structures. Alex Azar, HHS Secretary, and Seema Verma, …
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New Plan Designs for Medicare Parts C and D are Coming
April 9, 2019 | Christopher J. Kutner | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On April 5, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-4185-F) that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients. The final rule will increase MA plan choices for the 2019 …
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New York State Budget Includes ACA-Type Protections
April 3, 2019 | Eric D. Fader | Affordable Care Act | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
New York’s state budget for the 2019-2020 fiscal year, approved by the State Legislature on March 31, included provisions that codify into state law the primary consumer protections of the federal Affordable Care Act. In a public announcement, Gov. Andrew Cuomo said, “We have codified many of the protections of Obamacare, so regardless of what …
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CMS Accepting Applications for AI Contest
March 28, 2019 | Cassandra Rivais DiNova | Electronic Health Records | Hospitals | Legislation and Public Policy | Medicare and Medicaid
On March 27, the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) announced an artificial intelligence contest. The CMS Artificial Intelligence (AI) Health Outcomes Challenge, in collaboration with the American Academy of Family Physicians and the Laura and John Arnold Foundation, is looking for innovative technology and strategies to predict health outcomes, …
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EHR Exposé Shakes Up Industry
March 19, 2019 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Hospitals | Legislation and Public Policy | Litigation | Medicare and Medicaid
A three-month joint investigation of electronic health records (EHR) systems has culminated in a release of a March 18 article in Kaiser Health News (KHN) and Fortune Magazine, “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong.” The lengthy, meticulously sourced article calls EHR systems “an unholy mess.” KHN and Fortune have made the …
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Managing “Social Determinants of Health” a Key Issue for Health Systems
March 14, 2019 | Rivkin Rounds Staff | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid
The World Health Organization (WHO) defines social determinants of health (SDOH) as the conditions in which people are born, grow, live, work and age that are primarily responsible for differences in health status. Rivkin Radler’s Robert Iseman recently penned a Thought Leaders’ Corner column for Population Health News in which he made suggestions regarding how healthcare organizations …
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CMS to Propose Significant Changes to Stark Law
March 7, 2019 | Cassandra Rivais DiNova | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
At the Federation of American Hospitals’ 2019 Public Policy Conference on March 4, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced the agency’s plan to make dramatic changes to the federal physician self-referral prohibition, commonly known as the Stark Law. The changes are designed to support a value-based model of care in …
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CMS Proposed Rule Focuses on Patient Access to Health Info
February 21, 2019 | Eric D. Fader | Electronic Health Records | HIPAA | Hospitals | Legislation and Public Policy | Medicare and Medicaid
Yesterday’s Rivkin Rounds post discussed the Proposed Rule on information blocking recently released by the Office of the National Coordinator for Health Information Technology (ONC). The Centers for Medicare & Medicaid Services (CMS) simultaneously released its own 251-page Proposed Rule, addressing some of the same concerns but focused on interoperability and patients’ access to their …
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