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Medicare has proposed limiting coverage of Aduhelm, the costly new drug to treat Alzheimerās disease, and several prominent groups representing patients and their families are pressing the program to make it more widely available. But among individuals facing the disease, the outlook is more nuanced.
Private and public employers are increasingly using the governmentās Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. As a result, the federal government is paying the āoverwhelming majorityā of medical costs, according to an industry analyst.
CMS chief Chiquita Brooks-LaSure says the agency reserves its power to quickly institute new regulations for āabsolute emergencies.ā On staffing, nursing home residents might need to wait years to see any real change.
Almost a year after the American Rescue Plan Act allocated what could amount to $25 billion to home and community-based services run by Medicaid, many states have yet to access much of the money due to delays and red tape.
The president wants to set minimum staffing levels for the beleaguered nursing home industry. But, given a lack of transparency surrounding the industryās finances, itās a mystery how facilities will shoulder the added costs.
An epic battle is playing out behind the scenes over whether the government should pay for Aduhelm, an FDA-approved Alzheimerās drug that scientists say has not been proven to work.
State Medicaid agencies for months have been preparing for the end of a federal mandate that has prevented states from removing people from the safety-net program during the pandemic.
Congress is set to start its once-every-five-years review of the law that authorizes user fees to finance the hiring of personnel to speed the FDA review of drugs. The periodic renewals of āPDUFAā also give lawmakers a chance to make other changes to the agency at the hub of the pandemic. Meanwhile, the FDA could also find itself at the center of the abortion debate and a controversial new medication to treat Alzheimerās disease. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sarah Karlin-Smith of the Pink Sheet join KHNās Julie Rovner to discuss these issues and more.
The Biden administration is getting rid of several policies implemented by Trump-era appointees that restricted enrollment. Federal officials now say states can no longer charge premiums to low-income residents enrolled in Medicaid and have ruled out work requirements.
Among the 764 hospitals hit with a 1% reduction in Medicare payments this year for having high numbers of patient infections and avoidable complications are more than three dozen that Medicare also ranks as among the best in the country.
As omicron surges, more nursing homes are facing a double whammy: Lab tests are taking too long, and fast antigen tests are in short supply.
If federal officials accept a courtās decision, some patients will get a chance to seek refunds for their nursing home and other expenses.
Relatives say it is important they be allowed to go into nursing homes because staff shortages are affecting care. And many are still upset about lengthy separations from loved ones during lockdowns earlier in the pandemic.
The court is considering whether to let the rules go into effect as opponents fight them in lower courts. Conservative justices pressed lawyers hard about whether the administration overstepped its authority, but liberal members of the high court questioned why the government shouldnāt be expected to move forcefully when facing a severe health crisis.
Facility fees, designed to help hospitals cover the high cost of staying open 24/7, have long rankled consumers. Now, some patients are assessed the fees while sitting at home for a telehealth appointment.
California wants to hold nursing homes accountable for the quality of care they provide by tying Medicaid funding more directly to performance. But the nursing home industry, an influential player in the Capitol, is gearing up for a fight.
Medicare billing codes for audio-only follow-up check-ins lead to new reimbursement battles.
The Republican senator says President Joe Bidenās āinflation crisisā caused Medicare to raise monthly premiums, which will add hundreds of dollars to beneficiariesā costs. But Medicare experts say inflation was not to blame and most beneficiaries will shoulder a much smaller increase than what Rick Scott claims.
Medicare officials say complaints are rising from seniors lured into private plans with misleading information or enrolled without their consent. In response, officials have threatened to penalize the private companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.
Some insurers pocketed āeye-poppingā overpayments, billing records show.
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