CMS Rule to Improve Medicare Part B Prescription Drug Models

This controversial rule could change how doctors profit from using the most expensive drugs – Washington Post

Medicare’s Cancer Drug Experiment Annoys Specialists – NBC

Read the CMS proposal here and related article from the Motley Fool  (9 Drugs That Cost Medicare a Fortune)

News over the weekend

At the start of the weekend,  Bloomberg reported that “UnitedHealth Group Inc., the largest U.S. health insurer, has decided to call it quits in two state Obamacare markets. The insurer won’t sell plans for next year in Georgia and Arkansas, according to state insurance regulators. ”

In a column report by the  Los Angeles Times   however,  mentioned “United, which makes most of its money in the large-group (employer) market, always was a reluctant participant in the individual exchanges, and was largely inept at pricing and managing those products. “

Where do you stand on the Affordable Care Act?

Last March was the 6th anniversary of  the Affordable Care Act (ACA).  According to this report from, 20 million people now have healthcare coverage and that 4.3 million jobs have been created.

This report by, however, said that “not all insurance is good insurance . Unnecessary over-insurance promotes overutilization and drives up costs for everyone.” The report further argues that the ACA was introduced after the recession — the economy always adds jobs after a recession.

This chart from Kaiser Family Foundation shows us how deeply divided the public has remained on the health reform law since it was passed in March 2010.

Other articles for the day:

Does Medicaid Expansion Improve Revenue of Hospitals? – RevCycle Intelligence

Utah Limits Medicaid Expansion to Individuals with ‘Greatest Need’ – Heartland


Implications of Expanding Medicaid Eligibility

Tens of thousands of Ohioans could lose Medicaid coverage under fee proposal – The Columbus Dispatch

Support for Medicaid copays plan is crumbling –

Oklahoma Eyes Obamacare Funds, But Without Medicaid Expansion –

Hutchinson’s plan to rework Medicaid expansion passes House, Senate – Arkansas Online

Expanding Medicaid Eligibility Would Help Low-Income Workers Find Better Jobs: Study – International Business Times

Medicaid in the News

Florida settles lawsuit over pediatric Medicaid patients’ access to care -Modern Healthcare

D.C. Must Fix Lingering Medicaid Problems – Courthouse News Service

Woman publicly shames Florida Governor Scott for anti-abortion bill, Medicaid cut -Fox 59

Bentley: Medicaid will try cuts before he considers special session

“They don’t care,” Nursing home residents, staff challenging proposed Oklahoma Medicaid cuts –

Medicare Advantage Rate Hike: What to Expect

CMS has finalized a number of payment and policy changes to the Medicare Advantage and Part D prescription drug programs for 2017, including a slight payment increase to health insurers who offer Medicare Advantage plans.(Becker’s Hospital CFO)

The U.S. is raising payments to the insurers by 0.85 percent on average, according to a statement Monday from the Centers for Medicare and Medicaid Services, down from the 1.35 percent boost proposed in February. Payments to individual insurers can vary, because CMS gives individual plans quality bonuses and premiums are adjusted based on where enrollees live and how sick they are. (Bloomberg)

Over the past several weeks, lawmakers, insurers, employers and others had expressed concern that the policy would shift more costs onto beneficiaries, and wouldn’t give employers and insurers enough time to adjust their coverage plans for 2017. (Morning Consult)

The Better Medicare Alliance said it’s “deeply concerned” by the upcoming changes to retiree coverage. But AHIP CEO Marilyn Tavenner — a former administrator of CMS — struck a more moderate tone. “Following this overwhelming bipartisan Congressional outreach, CMS took steps to mitigate the negative impact of policy changes related to risk adjustment and encounter data,” Tavenner allowed. “Yet, more can be done to ensure stability for more than three million seniors who depend on Medicare employer retiree plans.”(Politico)


Managed Care News Feed – Monday

CMS proposes Medicaid change – Modern Medicine

Medicaid Not Big Enough? Obama Administration Proposes $100 Billion More Spending –

Medicaid and the Entitlement Reform Debate–

CMS proposes pay raise for Medicare Advantage plans – Washington Post

CMS proposes payment changes for group Medicare Advantage plans -Employee Benefit News

Feds increase push to keep seniors out of nursing homes

Final Medicare Advantage rates largely shun health plan lobbying -Modern Healthcare

CMS pitches smaller increase for Medicare Advantage payment rate – Healthcare Finance

Health care adds 503,000 jobs in just one year – Politico