Center for Medicare Advocacy: Advocates Urge Biden Administration to Take Immediate Action on Key Issues Facing Medicare Beneficiaries
Targeted News Service
Feb. 9, 2021:
U.S. Department of Health and Human Services (HHS) Acting Secretary
Norris Cochran, two leading Medicare beneficiary advocacy organizations, the
Center for Medicare Advocacy and the Medicare Rights Center, urge the
Biden Administration to take swift action to strengthen Medicare, Medicaid, and the Affordable Care Act. As outlined in the letter, matters requiring immediate attention include simplifying Medicare transitions during the COVID-19 public health emergency, enhancing Medicare outreach and enrollment strategies, and increasing regulatory review efforts. Looming deadlines and unmet needs make these improvements urgent.
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In November 2020, the Department of Health and Human Services (HHS) finalized a regulation aimed at lowering prescription drug prices and out-of-pocket spending for prescription drugs by excluding rebates on prescription drugs paid by manufacturers to or purchased by Medicare Part D plan sponsors or pharmacy benefit managers (PBMs) acting under contract with Medicare Part D plan sponsors from the existing discount safe harbor under the federal Anti-Kickback Statute (AKS).
1 The regulation reflects the first change to the AKS discount safe harbor since the Medicare Part D program was established.
On December 3, 2020, Centers for Medicare & Medicaid Services (“
CMS”) announced key details concerning a new value-based reimbursement and patient care model – the Geographic Direct Contracting Model (the “
Model” or “
Geo”). Geo is a geographic-based approach to value-based Medicare reimbursement and patient care that focuses on improving health outcomes and decreasing the cost of care across an entire geographic region. Direct contracting entities (“
DCEs”) participating in the Model will be taking responsibility for the total cost of care of Medicare fee-for-service beneficiaries in their region. Accountable care organizations (ACOs), health systems, health care provider groups, health plans, and other potential applicants will be permitted to participate in the Model as DCEs. The Model intends to encourage care coordination across a physical, geographic area and to deliver care that considers a region’s particular local needs.[1]