CMS-Proposed Rules Would Cap Medicare Advantage Broker Incentives
The Centers for Medicare and Medicaid Services are launching a second-wave effort to target Medicaid Advantage marketing practices in an effort to ensure older Americans have access to Medicare supplemental benefits and drug coverage.
Modern Healthcare:
Medicare Advantage Prior Authorizations Tightened Under CMS Proposal
Medicare Advantage insurers face new regulations governing marketing, prior authorizations and supplemental benefits under a proposed rule the Centers for Medicare and Medicaid Services issued Monday. The draft regulation also would raise network adequacy standards and promote the use of biosimilar medications, and is another step in a campaign by President Joe Biden's administration to rein in the health insurance companies participating in Medicare Advantage. (Tepper, 11/6)
Stat:
Government Looks To Tinker With New Caps On Medicare Advantage Broker Payments
The federal government is proposing to rein in health insurance companies that entice brokers with lavish bonuses to sell their Medicare Advantage plans by placing a firmer cap on broker compensation. (Herman, 11/6)
The Washington Post:
Biden Administration Seeks To Crack Down On Private Medicare Health Plans
Under a draft rule issued Monday by the federal Centers for Medicare and Medicaid Services, Medicare Advantage plans would be required to work harder to encourage customers to make use of extra benefits available to them, rather than the companies merely invoking them as a selling point. The proposal also would help Americans with Medicare drug benefits gain access to biosimilars, less expensive versions of biologic drugs made from living cells or other organisms. (Goldstein, 11/6)
USA Today:
Biden Tackles Medicare Advantage Plans: These Are The Proposed Changes
“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra. If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs. Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans. (Groppe, 11/6)
More Medicare developments —
Reuters:
Exclusive: Cigna Explores Shedding Medicare Advantage Business -Sources
U.S. health insurer Cigna Group (CI.N) is exploring the sale of its Medicare Advantage business, which manages government health insurance for people aged 65 and older, a move that would mark a reversal of its expansion in the sector, according to people familiar with the matter. Cigna, which got into the Medicare Advantage business with its $3.8 billion acquisition of HealthSpring in 2011, would be backing away at a time the U.S. government is tightening its purse strings in reimbursing health insurers for their services, should it go through with the move. (Carnevali, 11/6)
Mother Jones:
Donald Trump Freed A Convicted Medicare Fraudster. The Justice Department Wants Him Back.
On a Thursday in September 2019, Philip Esformes arrived for his sentencing at the federal courthouse in downtown Miami looking pale and gaunt. The previous April, after an eight-week trial, Esformes, heir to a large, successful chain of nursing homes, had been convicted of fraud, kickback and money laundering crimes, and obstruction of justice. Citing more than $1 billion in false reimbursement claims, prosecutors described him as the linchpin of the “largest single criminal health care fraud case ever brought against individuals by the Department of Justice.” Esformes, then 50, had been in jail since his arrest more than three years earlier. The deep tan he ordinarily cultivated had faded. He’d developed skin rashes and shed some 50 pounds. (Pomorski, 11/1)
In related news about prescription drug costs —
Stat:
On Drug Prices, HHS Secretaries Becerra And Azar Duke It Out
Two very different health secretaries took the stage Monday to defend their presidents’ plans — failed and not — to bring down high drug costs. President Biden’s Health and Human Services Secretary Xavier Becerra praised Medicare’s new powers to negotiate drug prices, fighting back against the now-common refrain that it would delay drug launches and curb innovation, this time lodged by Trump HHS Secretary Alex Azar. (Owermohle, 11/6)
Modern Healthcare:
CMS, HHS Understate 340B 'Clawback's' Financial Impact, Lawyers Say
Providers participating in the 340B drug discount program will receive $9 billion by early next year under a regulation finalized Thursday designed to compensate hospitals for 340B payment cuts in previous years. Industry pushback could set the stage for another protracted legal battle surrounding the 340B program, which offers estimated 25%-50% discounts on outpatient prescription medicines to safety-net hospitals and other providers that treat low-income and uninsured patients. (Kacik, 11/6)
