California: Proposed Legislation Regulating Health Care Rates for Payors and Providers


An ambitious California proposal to regulate health care rates and curb long-term health care spending was unveiled last week in Assembly Bill 3087 (Proposed Legislation).  The key concept in the Proposed Legislation is the establishment of an independent commission with the authority to set the rates paid for health care services in most commercial contexts.  The Proposed Legislation —following on the heels of single-payor legislation debated last summer—proves that interest in sweeping health care reform remains high among California lawmakers.  While it is too early to tell whether AB 3087 or something similar will gain traction, here are five key aspects of the bill in its current form:

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OIG Report: CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements


The Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just published a new report on OIG’s review of Medicare payments for telehealth services. The objective of the OIG review was to determine whether or not CMS paid practitioners for telehealth services that met Medicare requirements. The report concluded that, of the sampled claims reviewed by OIG, 31% did not meet the Medicare conditions for payment for telehealth services. Extrapolating the data, OIG estimated that Medicare could have saved approximately $3.7 million during its audit period if practitioners had provided telehealth services in accordance with Medicare requirements.

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Medicare Enrollment for Providers No Longer Required Under Medicare Parts C and D

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On April 2, 2018, CMS released the Contract Year 2019 Final Rules for Medicare Advantage (MA) and Part D (the MA Final Rule), incorporating changes that support CMS’ stated commitment to supporting flexibility and efficiency throughout the MA and Part D Programs.

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Medicaid Drug Rebate Agreements: Changes Require Immediate Action By Pharmaceutical Manufacturers


For the first time since the enactment of the Medicaid Drug Rebate Program (MDRP), the Centers for Medicare and Medicaid Services (CMS) revised the National Medicaid Drug Rebate Agreement (NDRA) entered into between drug manufacturers and the U.S. Department of Health and Human Services (HHS).

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