CY2019 DME Proposed Rule Alters Competitive Bidding Program

Jul 24, 2018 | DMEPOS

CMS has proposed the annual DME rule with revisions to the Competitive Bidding Program (CBP) and for multi-function ventilators that are not part of the CBP. Both proposals are modest positive for industry participants. In addition CMS indicates that the bidding cycle for 2019 will be delayed and prices will be held steady until CMS can conduct the bidding process for an effective date some time after January 1, 2019.Click here to read more.

Recent 340B Program Developments

Jul 23, 2018 | 340B, Hospitals

There have been several recent noteworthy policy and legislative developments related to the 340B drug pricing program. The program, which requires drug manufacturers to sell outpatient drugs at a discount to covered entities, has been under pressure from policymakers as well as lawmakers under the Trump Administration. This brief discusses recent developments related to 340B reform, including a recent GAO report, comments made by HHS Secretary Azar, and recently proposed legislation. Read more here

KY Medicaid Work Requirement Invalidated, States Consider Next Steps

Jul 19, 2018 | Medicaid

On June 29, a Federal court invalidated parts of Kentucky’s Medicaid waiver, including work requirements for the expansion population. While CMS considers whether to appeal, other states are determining how to proceed with work requirements and other enrollment conditions for the expansion population. Click to read more.

CY2019 Proposed ESRD Rule

Jul 19, 2018 | ESRD

CMS has released its annual ESRD proposed rule.  CMS estimates the impact of the proposed CY 2019 changes to be a 1.7% increase in payments – including a 1.5% base rate increase plus a 0.2% increase due to changes in outlier payments. Click to read more.

Medicare Overpays For DME Products Not In Competitive Bidding Program

Jul 18, 2018 | DMEPOS, MedPAC

The Medicare Payment Advisory Commission (MedPAC) recently released a report that compared Medicare rates for durable medical equipment (DME) not subject to competitive bidding to rates paid by commercial plans. MedPAC found that Medicare was paying as much as 20% to 60% higher for some products, such as orthotics, ventilators, and diabetic supplies. MedPAC used a leading national commercial database, Truven MarketScan data for its analysis, using 2015 data. BRG also utilizes Truven’s MarketScan data to analyze commercial rates at the local (Metropolitan Statistical Area), state, and...