CMS Reverses Trump-Era Limits On Drugs Covered By Medicare Part D
The Trump administration had planned to allow some 2022 Medicare Part D plans to not cover all drugs in five of the six protected classes. CMS' Center for Medicare and Medicaid Innovation has now halted that change.
Modern Healthcare:
CMS Ends Policy Allowing Some Part D Plans To Cover Fewer Drugs
The Biden administration on Tuesday ended a Trump-era policy that would have allowed Medicare Part D plans to cover fewer drugs under a new pay model. When CMS' Center for Medicare and Medicaid Innovation requested Part D Payment Modernization applications for 2022 in January, it said that plans participating in the model wouldn't have to cover all drugs in five of the six protected drug classes: anticonvulsants, immunosuppressants, antidepressants, antipsychotics and antineoplastics. It also allowed Part D plans to only include one drug per class in their formulary instead of two drugs, as currently required, and paused the 10% downside risk requirement for model participants during the 2022 plan year. (Brady, 3/17)
Modern Healthcare:
Nephrologists Frustrated Over CMS' Delay Of Kidney Program
Providers caring for patients with chronic kidney disease are scrambling to update their operations after the Center for Medicare and Medicaid Innovation delayed starting a new value-based payment program just weeks before it was set to go live. CMS was unable to respond to an interview request about how many nephrologists and other providers will be impacted by the delay in the Kidney Care Choices program. But the program received more applications than expected, according to Mark Gooding, an associate principal at the Avalere consultancy. (Tepper, 3/17)
In more CMS news as well as Medicaid —
Georgia Health News:
Georgia Vows To Continue Fight If Feds Kill State’s Medicaid Waiver Plan
Georgia officials, as expected, have appealed the new federal position on the state’s Medicaid waiver plan, saying its possible revocation by the Biden administration would be ‘‘an arbitrary and unlawful bait-and-switch.’’ The commissioner of the state’s Department of Community Health, in a letter dated March 12, noted that federal health officials last year approved Georgia’s approach to require low-income adults to meet work or other eligibility standards to get Medicaid coverage. Those requirements were at the center of the Biden administration’s criticism last month of the Georgia plan, which is scheduled to begin July 1. (Miller, 3/17)
Modern Healthcare:
Two States Could Be Next Medicaid Expansion Battlegrounds
Advocates say they see new political momentum for expanding Medicaid in some conservative states after Congress recently offered them billions of dollars in additional funding to do what 38 states have already done: extend insurance coverage to millions of low-income Americans. Under the most recently passed COVID-19 relief bill, the 12 states that have not yet expanded Medicaid under the Affordable Care Act would get even more money from the federal government to do so, prompting hope among advocates including hospitals and providers that the tide could be turning. (Hellmann, 3/17)
North Carolina Health News:
Big Medicaid Expansion Incentives In Pandemic Relief Bill
For the third year in a row, leaders from rural parts of North Carolina came out to say that they believe the state should move to close the health care coverage gap that’s only widened since the start of the pandemic. In a statement released on March 4, the five rural members of Gov. Roy Cooper’s Council on Health Care Coverage, which met throughout the winter, said they believed the answer was “obvious.” That answer was to expand Medicaid. (3/18)
CIDRAP:
Race, Medicaid Status Tied To Higher COVID-19 Rates In US Nursing Homes
Among 3,008 US nursing homes in counties in the top quartile of COVID-19 prevalence, those with larger proportions of racial minority residents, Medicaid participants, and fewer direct patient care hours experienced more coronavirus infections amid the pandemic, according to a research letter published yesterday in JAMA Network Open. The study, led by researchers from the University of Pennsylvania in Philadelphia, involved analysis of data from the Centers for Medicare & Medicaid Services (CMS) Nursing Home COVID-19 Public File, the 2017 Long-term Care: Facts on Care in the US database, the USAFacts website, and the 2017 American Community Survey. (3/17)
