Healthcare Reform News Updates20

Healthcare Reform News Updates

To keep you updated on the latest news regarding healthcare reform, we have provided a summary of recent events below.

Healthcare Reform Update for August 25, 2023.

Medicare’s ACO care model saves $1.18 billion.

According to the Centers for Medicare and Medicaid Services, Medicare’s accountable care organization will save an estimated $1.8 billion by 2022 while enhancing senior care for millions of people.

The Medicare Shared Savings Program made money for the sixth year in a row, which is the second-highest annual saving in more than a decade.

CMS Administrator Chiquita Brooks-LaSure stated that the Medicare Shared Savings Program “advance[s] coordinated health care for millions of Medicare beneficiaries while also lowering costs for the Medicare program.

According to Brooks-LaSure, “CMS will keep enhancing the program, and it is encouraging to see that Accountable Care Organizations are continuing to be successful in providing coordinated, high-quality, affordable, equitable, and person-centered care.”.
Health Reform Update for August 4, 2023.
A GUIDE was developed to enhance Alzheimer’s patients’ care and quality of life.
Alzheimer’s dementia is thought to affect 6.7 million Americans over the age of 65 in the U.S. To improve care and quality of life for elderly people with Alzheimer’s and their unpaid caregivers, the Department of Health and Human Services recently unveiled a new guide.
A collaboration between HHS, the Centers for Disease Control and Prevention, and the Centers for Medicare & Medicaid Services led to the development of the Guiding an Improved Dementia Experience Model (GUIDE).
HHS Secretary Xavier Becerra states that the department “continues to innovate” to assist Americans who are living with dementia and their unpaid caregivers.
Becerra continued, “Our new GUIDE Model has the potential to enhance the quality of life for those with dementia and lessen the significant burden on our families.
The GUIDE Model has FOUR main objectives: 
the enhancement of dementia patients’ quality of life.
alleviate the burden on unpaid caregivers.
Encourage people to stay in their homes and communities.
Enhance services for respite care, caregiver support and education, and care coordination.
To assist seniors with Alzheimer’s and their unpaid caregivers in obtaining:, a care navigator will also be assigned to them.
Services for clinical care.
non-clinical services provided by community-based organizations, like meals and transportation.
“As millions of Americans already know, dementia can devastate people and their families in many ways,” claims Liz Fowler, Deputy Administrator of CMS and Director of the Innovation Center.
Update on Healthcare Reform as of July 28, 2023.
612,000 Medicare beneficiaries are harmed by a data security breach.
A recent data security breach at a Medicare contractor exposed the private information and health records of approximately 612,000 Medicare recipients.
On Maximus Federal Services, Inc.’s corporate network, the data breach took place between May 27 and May 31, 2023. as a result of a third-party application gaining access via Progress Software’s MOVEit Transfer software.
The MOVEit hack was a component of a larger data security incident that exposed the private information of over 130 organizations, including Medicare, and compromised the privacy of an estimated 15 million people.
A letter from Medicare to beneficiaries states that the incident “involved a security vulnerability in the MOVEit software, a third-party application which permits the transfer of files during the Medicare appeals process.”.
Alert plus free credit monitoring.
CMS and Maximus Federal Services will send affected Medicare beneficiaries a letter with information about the data breach.
Additionally, Maximus is providing free credit monitoring for 24 months to those who have been affected.
For July 20, 2023, see Healthcare Reform Update.
How it functions.
Groups of physicians, hospitals, and other healthcare organizations are included in Medicare’s ACO.
They work together to give Medicare recipients coordinated, excellent care.
Saving money, reducing medical errors, and avoiding unnecessary services are all benefits of this.
Additionally, it decreases ER visits and healthcare costs for Medicare beneficiaries.
The numbers behind the Medicare Shared Savings Program are as follows:.
573,000. Currently, the Medicare Shared Savings Program includes over 573,000 clinicians.
eleven million. About 11 million Medicare recipients are treated by these clinicians.
8 major health concerns. Clinicians are exceptional at assisting patients with eight critical health issues: blood pressure control, diabetes management, breast and colorectal cancer screening, tobacco screening, smoking cessation, depression screening, and follow-up.
63 % receive performance bonuses. The Medicare Shared Savings Program paid performance-based payments to about 63 percent of ACOs in 2022.
Update on Healthcare Reform for August 18, 2023.
Medicare program costs are decreased by the Inflation Reduction Act.
The Inflation Reduction Act of 2022, which was enacted a year ago, has caused Medicare beneficiaries to spend less on prescription drugs, health plan premiums, and out-of-pocket expenses.
The Inflation Reduction Act contains specific provisions to assist in lowering the cost of Medicare, such as:.
Limiting the price of an insulin supply for a month for Medicare recipients to no more than $35.
reducing the price of prescription drugs covered by Medicare Part D.
offering Medicare recipients free access to the adult vaccines that are advised.
enabling drug manufacturers to bargain with Medicare about the cost of prescription medications.
requiring pharmaceutical companies to rebate Medicare if their price increases are greater than the rate of inflation.
The new law “provides meaningful financial relief for millions of Medicare beneficiaries by enhancing access to affordable treatments and strengthening the Medicare Program both now and in the long run,” CMS stated in a press release issued on August 16, 2023.
Additionally, the Inflation Reduction Act of 2022 offers improved financial assistance for purchasing health insurance through or state-based marketplaces.
Healthcare Reform News Updates
Update on Healthcare Reform as of August 11, 2023.
According to the HHS, the national uninsured rate has never been lower.
According to a recent report from the U.S. The national uninsured rate decreased to an all-time low of 7.7 percent earlier this year. S. the Department of Health and Human Services.
The National Health Interview Survey’s enrollment data for the first quarter of 2023 was examined by analysts. They discovered that the number of uninsured individuals fell to a record low, with the uninsured rate falling by an estimated 6.3 million since 2020.
The Inflation Reduction Act, according to HHS Secretary Xavier Becerra, “has played a critical role in helping more Americans afford coverage through the Affordable Care Act.”.
The following are some crucial factors that contributed to a decrease in the uninsured rate.
Improved Affordable Care Act subsidies provided by the American Rescue Plan will aid in reducing the cost of health insurance.
Fixing the “family glitch” in the ACA will help the estimated 5 million people who can access employer-sponsored insurance pay less for health insurance.
The Inflation Reduction Act has expanded its subsidies.
expansions of state Medicare.
“This year, the uninsured rate in the country reached an all-time low, even breaking the record from last year,” claims Becerra. “HHS will continue to do everything we can to support Americans in maintaining or obtaining coverage and gaining access to high-quality, reasonably priced healthcare. “.
Update on Healthcare Reform for July 20, 2023.
In a scheme to defraud Medicare outright, two men entered guilty pleas.
Two Florida men recently entered a plea agreement after admitting that between January 2020 and July 2021, they submitted $67 million in false claims to Medicare.
In a telemarketing scam for genetic testing and durable medical equipment, Daniel M. Carver and his brother Louis “Gino” Carver targeted Medicare recipients.
In line with U. S. According to the Department of Justice and court records, the Carver brothers paid bribes and kickbacks to telemedicine companies for:.
Falsifying patients’ and doctors’ signatures on paperwork related to health.
making fabricated medical orders.
Ordering genetic tests that are not required by medicine.
Ordering long-term medical supplies that are not required by medicine.
Daniel Carver could spend up to 25 years behind bars for conspiring to.
Commit fraud in the healthcare industry.
Fraudulently use wire transfers.
Take advantage of the US.
Kickbacks are paid and received.
For conspiring to:, Lois Carver could spend up to 10 years in prison.
Defraud the healthcare system.
On December 5, 2023, a federal district court will sentence the Carver brothers.
Five additional participants in this $67 million Medicare fraud scheme have already entered guilty pleas and are currently awaiting sentencing.
Update on Healthcare Reform for July 13, 2023.
Beneficiaries will save $7.4 billion annually thanks to changes to Medicare Part D.
According to a recent report from the U.S. government, the Inflation Reduction Act’s changes to Medicare Part D will save beneficiaries an estimated $7.4 billion annually by 2025. S. Office of Health and Human Services.
Seniors will primarily benefit from this as the Medicare Drug Price Negotiation Program moves forward with the changes outlined in the Inflation Reduction Act.
An annual limit of $2,000 on prescription drug out-of-pocket expenses.
18.7 million enrollees will save, on average, $400 annually on prescription medications.
Beginning in 2025, an estimated 1.9 million enrollees will experience annual savings of at least $1,000 on prescription medication.
An annual savings of roughly $7.4 billion for seniors who pay out-of-pocket for prescription drugs.
“The Biden-Harris Administration is committed to assisting seniors and people with disabilities save money on the medications they need and ensuring that hardworking families have insurance when they need it,” said HHS Secretary Xavier Becerra.
Update on Healthcare Reform for June 30, 2023.
CMS announces changes and a schedule for Medicare drug price negotiations.
By September 1, 2023, the Medicare Drug Price Negotiation Program’s first 10 drugs will be revealed by the Centers for Medicare & Medicaid Services.
CMS recently released updated guidelines and crucial dates to make the drug selection and negotiation process more clear.
Based on the drugs:, CMS will select the first 10 medications for the Medicare Drug Price Negotiation Program.
Clinical gain.
Possibility of meeting an unmet medical need.
effect on Medicare beneficiaries.
Expenses for production, distribution, and research and development.
CMS Administrator Chiquita Brooks-LaSure says that by guaranteeing that Medicare beneficiaries can afford the prescription medications they require, the agency is better able to safeguard their health.
Negotiating drug prices with manufacturers will increase millions of Medicare recipients’ access to lifesaving medications while fostering market competition and technological advancement.
Healthcare Reform Update for June 27, 2023.
A $10 million Medicare fraud conviction is the result of an FBI investigation.
A physician assistant based in Charlotte, N.C., who was the subject of a Federal Bureau of Investigation investigation, was found guilty of $10 million in Medicare fraud in federal court on June 13, 2023.
A 35-year-old Monroe, N. C., was found guilty of six counts of making false statements about healthcare-related issues and one count of healthcare fraud.
That Joyner: was discovered by FBI investigators.
Between 2018 and 2019, while working as a contractor for a telemedicine company, I authorized hundreds of Medicare beneficiaries’ fraudulent prescriptions and genetic tests.
For each fraudulent prescription or genetic test he signed and submitted, the telemedicine company paid him $12 to $15.
Falsified medical records were created to hide the fact that the beneficiaries’ beneficiaries had no medical evaluations or examinations performed on them and that he was not listed as the treating physician.
More than $3.6 million was paid out as a result of $10 million in false Medicare claims.
Joyner used telemedicine technology to steal money from Medicare, according to Dena J. King, U.S. Legal representative for the Western District of North Carolina.
“As the telehealth industry expands, federal prosecutors and investigators are on the lookout for con artists who try to take advantage of this platform for their own gain. “.
For healthcare fraud, Joyner could receive a 10-year prison sentence and a $250,000 fine. For each count of making false statements about medical matters, he could receive a maximum sentence of five years in jail and a fine of $250,000.
21st of June 2023 Healthcare Reform News Update.
Drug manufacturers have filed a lawsuit in response to Medicare drug price negotiations.
This week, a pharmaceutical lobbying organization filed a lawsuit in federal court contesting specific provisions of the Inflation Reduction Act that permit Medicare to bargain drug prices.
The goal of the lawsuit brought by the National Infusion Center Association, the Global Colon Cancer Association, and the Pharmaceutical Research and Manufacturers of America (PhRMA) is to invalidate Medicare’s right to negotiate and set drug prices by the provisions of the Inflation Reduction Act.
The Inflation Reduction Act’s price-setting scheme, according to PhRMA President and CEO Stephen J., is a bad policy that jeopardizes both patients’ access to medicines and ongoing research and development. Ubl.
“We are hoping that the court will rule the price-setting provisions unconstitutional in light of the serious concerns raised. “.
The Inflation Reduction Act became official on August 16, 2022, when President Joe Biden did so. It has clauses like these to keep Medicare beneficiaries’ prescription drug costs under control.
The insulin price ceiling of $35 monthly.
Enabling Medicare to bargain directly with pharmaceutical companies to reduce the cost of prescription drugs covered by Medicare Part B and Part D.
Medicare beneficiaries’ annual pharmacy costs will be capped at $2,000 starting in 2025.
requiring pharmaceutical companies to give Medicare a rebate if their price increases exceed the rate of inflation.
It’s the fourth lawsuit filed in less than a year that contests Medicare’s capacity to bargain and regulate the price of prescription drugs. Pharmaceutical companies Merck and Co. and Bristol-Myers Squibb have brought similar lawsuits. The U.S. Additionally, the Chamber of Commerce has brought a legal action to contest Medicare’s ability to regulate the price of prescription drugs.
“We’ll zealously defend the President’s drug price negotiation law, which is already bringing down health care costs for the elderly and those with disabilities,” the U.S. According to Xavier Becerra, secretary of the Department of Health and Human Services.
2023 June 15 Healthcare Reform News Update.
From July 1, some Medicare drug costs will be reduced thanks to the Inflation Reduction Act.
43 prescription drugs may become less expensive for Medicare beneficiaries as of July 1 as a result of the Inflation Reduction Act.
According to the Centers for Medicare & Medicaid Services, this could save Medicare beneficiaries who rely on these medications between $1 and $149 per typical dose.
“With this provision, Medicare beneficiaries won’t have to worry about unexpected out-of-pocket price increases when drug companies raise prices faster than the rate of inflation,” says Dr. Meena Seshamani, Deputy Administrator and Director of the Center for Medicare.
“As CMS continues its methodical implementation of the law, this is just one of the many ways we are assisting Medicare recipients in realizing its impact. “.
In August 2022, President Joe Biden signed the Inflation Reduction Act into law. This legislation included a provision to assist in reducing the increase in the price of prescription drugs brought on by inflation.
The Inflation Reduction Act, which went into effect earlier this year, set a $35 monthly cap on the cost of prescription insulin for Medicare Part D enrollees.
Beginning July 1, 2023, there will be a cap on 43 more prescription medications for Medicare Part B.
According to Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, “The Medicare Prescription Drug Inflation Rebate Program is a critical way to address long-term price increases by drug companies.”.
Between July 1, 2023, and September 30, 2023, a lower Part B coinsurance will be applied to the 43 medications covered by the Medicare Prescription Drug Inflation Rebate Program.
8 June 2023 Healthcare Reform News Update.
To enhance primary care, CMS has launched a pilot program.
The Making Care Primary Model pilot program is being tested by the Centers for Medicare & Medicaid Services in eight states to enhance primary care.
It is a component of a 10-year objective to assist every Medicare beneficiary.
Receive important medical services by enrolling in a plan.
the improvement of health outcomes, accountability, and follow-up.
To increase access to care, broaden networks of healthcare providers.
CMS Administrator Chiquita Brooks-LaSure says that “this model focuses on improving care management and care coordination.”.
The people we serve will be helped with better managing their health conditions and achieving their health goals by providing primary care clinicians with the tools to form partnerships with health care specialists and by partnering with community-based organizations. “.
The following states are among those taking part in the pilot project for the Making Care Primary Model.
The state of New Jersey.
North Mexico.
City of New York.
The state of North Carolina.
The healthcare system will only get better if stability, resilience, and access to primary care are ensured, according to Liz Fowler, CMS Deputy Administrator and Director of CMS Innovation.
By 2030, we hope to have all Traditional Medicare beneficiaries and the vast majority of Medicaid beneficiaries enrolled in accountable care arrangements, including advanced primary care. The Making Care Primary Model represents an unprecedented investment in our country’s primary care network. “.
Later this year, CMS will evaluate primary care organizations’ applications for the pilot program from participating states. The initiative will start on July 1st, 2024.
For June 2, 2023, see the latest news on healthcare reform.
CMS asks the FDA for permission to pay for Alzheimer’s medications.
The Centers for Medicare & Medicaid Services is looking for U.S. The Food and Drug Administration has given permission in some situations for insurance companies to pay for the cost of medications used to treat Alzheimer’s disease.
According to estimates, 6 million U.S. S. the next 30 years, the number of people who have been diagnosed with Alzheimer’s disease is predicted to double.
Alzheimer’s is a progressive condition that impairs memory and brain function; it has no known cure. However, several medications seem to be able to slow the disease’s development.
Chiquita Brooks-LaSure, an administrator of CMS, stated that the agency has “always been committed to assisting people to obtain timely access to innovative treatments that meaningfully improve care and outcomes for this disease.”.
“CMS is ready to make sure that anyone with Medicare Part B who meets the requirements is covered if the FDA grants traditional approval,” states the FDA. “.
LEQEMBITM, a medication for Alzheimer’s made by Eisai Co., received FDA approval earlier this year.
On June 9, the FDA will examine data from a LEQEMBI clinical trial and could approve the CMS plan to cover Alzheimer’s medications.
Update on Healthcare Reform for May 30, 2023.
Medicare’s telehealth offerings are altered permanently by HHS.
The U.S. To enhance accessibility to behavioral and mental health services, the Department of Health and Human Services recently made permanent modifications to Medicare telehealth services.
The long-lasting modifications permit:.
Medicare beneficiaries may receive telehealth services for behavioral and mental health from licensed hospitals and clinics.
Medicare beneficiaries can receive in-home behavioral and mental health care through telehealth services.
No matter where they are physically located, any licensed medical facility or clinic may offer Medicare telehealth services for behavioral and mental health.
Delivering telehealth services over the phone or other audio-only platforms.
During the COVID-19 public health emergency, telehealth services for Medicare recipients underwent temporary changes.
However, the U.S. S. Following the end of the COVID-19 Public Health Emergency, which was announced on May 11, 2023, the Department of Health and Human Services made some of these changes permanent.
For May 19, 2023, see the latest news on healthcare reform.
Federal authorities accuse 18 suspects in the $490 million Medicare COVID-19 frauds.
The U.S. Recently, the Department of Justice filed charges against 18 suspects for allegedly defrauding the Centers for Medicare & Medicaid Services and other federal programs out of $490 million in COVID-19 testing kits and services.
Authorities from the federal government discovered the following schemes.
Buying Medicare beneficiary information and individual identities to commit fraud.
billing CMS for services related to COVID-19 that were not requested, provided, or medically necessary.
Shipping surplus COVID-19 test kits to Medicare beneficiaries, and in some cases, even to the deceased.
Making phony COVID-19 vaccination records.
Destroying the COVID-19 vaccine vials that were meant for patients.
Attorney General Merrick B. stated, “The Justice Department will not tolerate those who used the pandemic for their own financial gain and stole money from the taxpayers.”. Garland.
“This unprecedented enforcement action against defendants across the country shows that the Department is making full use of all tools at its disposal to combat and prevent fraud connected with COVID-19 and protect the integrity of taxpayer-funded programs. “.
Medicare fraud tip line: Call the Senior Medicare Patrol Resource Center at 1-888-851-1506 if you have Medicare or a private Medicare Advantage plan and you receive COVID-19 testing or medical supplies that you didn’t order.
Healthcare Reform News Updates
Update on Healthcare Reform News for May 12, 2023.
The Diabetes Program’s virtual services are now offered by CMS until 2023.
According to the Centers for Medicare & Medicaid Services, Medicare beneficiaries with diabetes will have access to virtual services as part of the Medicare Diabetes Prevention Program through the end of 2023.
When COVID-19 limitations restricted access to in-person care, CMS allowed diabetes care specialists to offer virtual services to Medicare beneficiaries. However, the end date for those services was May 11, 2023.
The Medicare Diabetes Prevention Program will now be able to continue offering virtual services through December 31, 2023, according to a CMS rule released on May 2, 2023.
As a result, Medicare beneficiaries with diabetes can receive services and data collection without having to be physically seen by a Medicare provider. These online resources for managing diabetes and weight include:.
Education about health.
In a group setting, wellness coaching.
approaches to managing your weight.
Measurements of body weight are gathered.
The Medicare Diabetes Prevention Program was created to aid those with prediabetes in preventing type 2 diabetes. The main objective is to assist Medicare recipients with prediabetes in losing at least 5% of their body weight and acquiring healthier lifestyle habits.
Update on Healthcare Reform for May 11, 2023.
Medicare Advantage plans were chosen by 50% of all beneficiaries, according to the report.
According to a recent report from the Centers for Medicare & Medicaid Services, private health insurance companies’ Medicare Advantage plans are chosen by 50% of all Medicare beneficiaries.
Enrollment figures for Medicare Advantage.
According to the most recent Medicare enrollment statistics, 30.19 million of the 59.82 million beneficiaries are enrolled in Medicare Advantage plans offered by private insurance companies.
Medicare Parts A and B (Original Medicare) are combined in Medicare Advantage plans, also known as Medicare Part C. These plans are provided by private insurance providers that have agreements with Medicare, giving patients yet another way to access Medicare benefits.
Enrollment in Medicare Advantage has grown by 13% since 2018. The Federal Trade Commission is now paying closer attention to senior-targeted advertising due to the rise in Medicare Advantage enrollment.
5 May 2023 Healthcare Reform News Update.
HHS makes data on 17,000 hospice and home-health organizations available to the public.
According to the U.S. Consumer Product Safety Commission, consumers now have a new method for assessing Medicare-certified hospice and home health agencies. S. Office of Health and Human Services.
6,000 hospices and 11,000 home-health agencies approved to participate in the Medicare program had ownership information from HHS released last month.
For enrollment details,:, clients can search the Medicare-certified databases of hospices and home-health care organizations.
The following dates are crucial ones for the Medicare Drug Price Negotiation Program.
The Medicare Drug Price Negotiation Program’s initial 10 drugs will be announced by CMS on September 1, 2023.
Drug manufacturers who have been chosen must sign an agreement to participate in negotiations by October 1, 2023.
The deadline for CMS to communicate negotiated drug price offers to involved pharmaceutical companies is February 1, 2024.
The deadline for participating pharmaceutical companies to accept, reject, or make a counteroffer for the negotiated drug price is March 2, 2024.
On September 1, 2024, CMS will publish the agreed-upon maximum fair prices for the first 10 medications selected for the program.
Negotiated drug prices go into effect on January 1, 2026.
Update on Healthcare Reform News for October 20, 2022.
A “family glitch” fix lifts 1 million more people’s health insurance subsidies.
According to the U.S., recent adjustments to the Affordable Care Act will assist about 1 million people in obtaining insurance or making their coverage more affordable. S. Office of Health and Human Services.
There was a “family glitch” in the ACA that raised costs for working Americans who had access to employer-sponsored health insurance.
By denying them access to marketplace subsidies, adding family members to employer-sponsored health plans made health insurance unaffordable for some people.
figuring out how much affordable health insurance will cost.
An employer-sponsored health plan for single coverage will be deemed affordable in 2022 if the cost to the employee is less than 9 point 61 percent of household income.
The Internal Revenue Service estimates that in 2023, this percentage will fall to 9.12%.
However, until recently, many working Americans could not afford coverage due to higher premiums for including family members in employer-sponsored health insurance.
13 October 2022 Healthcare Reform News Update.
CMS publishes annual Star Rating information so that Medicare plans can be contrasted.
To improve health, prevent disease, and manage healthcare costs, consumers 65 and older can benefit from comparing Medicare plans before making a purchase.
To aid in reviewing and comparing Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug coverage plans, the CMS recently released annual Star Ratings data.
Consumers frequently read reviews and weigh their options before making a purchase, including Medicare options.
95 percent of consumers read reviews before making a purchase, according to a recent survey.
According to 58% of respondents, they would even pay more for a good or service.
According to a CMS press release issued on October 6, 2022, “The Star Ratings system supports CMS’ efforts to empower people to make healthcare decisions that are best for them.”.
How to rate it in stars.
On a scale from 1 to 5, Medicare plans receive ratings. Five stars indicate exceptional performance, while one star denotes subpar performance.
Performance metrics are used to rate health plans.
Health maintenance: examinations, tests, and vaccinations.
Taking care of chronic (long-term) conditions.
health plan user experience.
Health plan performance changes and complaints from members.
service for health plans.
Ratings for drug plans are based on performance indicators for:.
Customer service for drug plans.
Complaints from members & performance changes with the drug plan.
Experiences of members with the drug plan.
medication safety and pricing accuracy.
Data from the Star Ratings each year.
Based on information provided by participants in Medicare Advantage and Part D prescription drug plans, Star Ratings are published yearly.
According to CMS data:.
In 2023, 72% of beneficiaries of Medicare Advantage plans with prescription drug coverage will be enrolled in a program with four or more stars.
In 2023, four stars or higher will be assigned to 51 percent of Medicare Advantage plans that cover prescription drugs.
2022 October 1 Healthcare Reform News Update.
In 2023, Medicare recipients will pay lower premiums.
According to the Centers for Medicare and Medicaid Services, the cost of Medicare Part B will decrease by 3% in 2023.
Before the start of Medicare Open Enrollment on October 15, the CMS announced last week that the Medicare Part B premiums would be decreasing.
Medicare premiums haven’t increased for more than ten years at this point.
The cost of Medicare Part B premiums increased by 14.5 percent in 2022, but in 2023, beneficiaries will pay:.
Monthly premiums are $164.90, which is $5.20 less than in 2022.
Deductible: $226 annual deductible, which is $7 less than in 2022.
Savings on Alzheimer’s medication aid in reducing Medicare premiums.
The cost of the pharmaceutical company Biogen’s drug Aduhelm, which is used to treat Alzheimer’s disease, was predicted to rise significantly by CMS last year. U. predicted that this would result in an increase in Medicare premiums. S. Xavier Becerra is the secretary of the Department of Health and Human Services.
The savings were used to lower Medicare premiums though, after Biogen lowered the price of the medication and CMS announced limited coverage of the drug.
In light of the sharp increase in the price of the Alzheimer’s drug Aduhelm, Becerra said, “I’m instructing the Centers for Medicare and Medicaid Services to reevaluate the recommendation for the 2022 Medicare Part B premium.”. “With Aduhelm’s price reduction of 50% starting on January 1, there is a strong case for CMS to reevaluate the prior recommendation. “.
According to a September 27 CMS press release, the 2022 premium included a contingency margin to cover anticipated Part B spending for…Aduhelm.
Larger reserves—which can be used to cap future Part B premium increases—were produced as a result of lower-than-anticipated spending on both Aduhelm and other Part B goods and services.
In 2023, seniors will also save money on the following expenses:.
The Inflation Reduction Act specifies a $35 cap on insulin product cost-sharing.
The Advisory Committee on Immunization Practices advises free adult vaccinations.
For September 22, 2022, see the latest news on healthcare reform.
OIG issues a warning about Medicare telehealth service fraud.
Telehealth services are increasingly being used by Medicare beneficiaries to access care.
According to data, between 2019 and 2020, the number of telehealth visits for Medicare beneficiaries increased from 840,000 to more than 52 million, or by 6,000%.
The Office of Inspector General, however, found that fraud, waste, and abuse of telehealth services for Medicare beneficiaries have increased recently.
The OIG discovered that in the study:.
1,714 of the 742,000 providers who submitted claims for Medicare-related telehealth services are at high risk for fraud, waste, and abuse.
To companies that “warrant further scrutiny” for fraud, waste, and abuse, Medicare reportedly paid $128 million for telehealth services.
For Medicare telehealth providers, fraudulent activity and risk factors are included.
charging for services that are not absolutely necessary.
ties to healthcare providers who have already been deemed to pose a high risk to Medicare.
identifying connections to well-known telehealth companies can be challenging.
To lessen Medicare telehealth fraud, waste, and abuse, some suggestions are as follows:.
Boost oversight and monitoring of telehealth companies that provide services to Medicare patients.
Inform telehealth professionals about proper billing procedures.
Make it mandatory for telehealth companies to include thorough details about the services they offer.
Identify telehealth businesses that accept Medicare payments.
Follow up with Medicare providers who exhibit signs of waste, fraud, and abuse.
Update on Healthcare Reform News for September 16, 2022.
Beginning in 2023, Medicare changes will place a price cap on insulin.
From January 1, 2023, insulin costs for Medicare Part D plans will be capped at $35 per month under changes to prescription drug costs outlined in the Inflation Reduction Act.
Diabetes affects 33% of Medicare recipients.
It is a cost-cutting measure intended to help control rising drug costs for the approximately 3 million Medicare beneficiaries who have diabetes and use insulin.
Researchers from Yale University found that after paying for their basic needs, 14% of people with diabetes who need insulin spend at least 40% of their income on it. Their findings were published in the journal Health Affairs.
The cost of prescription medications is regulated by IRA rules.
The first of several guidelines outlined in the IRA to help control prescription drug costs over the following 7 years is a cap on insulin costs for Medicare beneficiaries of $35 per month.
January 2023 will mark the start of the IRA’s.
Imposes a $35 monthly cap on insulin copayments for Medicare Part D plans.
requires pharmaceutical firms to make rebate payments if drug costs increase faster than inflation.
reduces the price of vaccines for Medicare beneficiaries.
Additional IRA regulations intended to reduce the price of prescription medications include:.
Medicare beneficiaries’ out-of-pocket prescription drug expenses are restricted to $4,000 or less.
Medicare Part D’s 5% coinsurance for catastrophic coverage should be eliminated.
Updating the cost of Medicare Part D cannot exceed 6% annually through 2029.
If drug costs rise faster than inflation, make drug companies pay rebates.
compel the federal government to bargain prices for more than 60 Medicare Part B and Part D medications.
Medicare beneficiaries’ out-of-pocket prescription drug expenses are restricted to $2,000 or less.
Update on Healthcare Reform for September 7, 2022.
beginning in October, new marketing regulations for Medicare Advantage. 1.
As of October 1, new guidelines established by the Centers for Medicare and Medicare Services must be followed by third-party marketing companies that promote Medicare Advantage plans.
Consumer complaints increased by 165 percent over the prior year, prompting CMS to closely examine Medicare plan third-party marketing strategies. The following complaints were made:.
1. Information that is incorrect in celebrity endorsement advertisements.
2. Benefits and promises like complimentary meals, complimentary transportation to doctor’s
3. Appointments, and cash payments for enrolling.
4. Fake enrollments and forged signatures.
5. False information regarding in-network providers and those who are not.
Some of the new Medicare marketing regulations went into effect on October 1. Some of them include:
Recording every conversation where beneficiaries and planners discuss the plan and archiving it for ten years.
Stating a prewritten disclaimer that reads, “I/We do not offer every plan available in your area,” within the first minute of a call or electronic communication. Any information we offer is only relevant to the plans we do have available in your area.
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