Skip to content
Find a Provider
The National Council logo

Archive: Medicare

Capitol Connector
Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

HHS Proposes Updates to Fraud and Abuse Laws

October 24, 2019 | Medicaid | Medicare | Comments
Image related to this article

Malka Berro

Policy Associate

Earlier this month, the Department of Health and Human Services (HHS) released a pair of proposed rules aimed at modernizing and clarifying the Stark Law and the Anti-Kickback Statute (AKS), two health care fraud and abuse laws. These new proposed rules aim to ease provider compliance burden and improve certainty for providers in value-based arrangements and for those who provide coordinated care. The rules also provide protections for providers transferring electronic health records and coordinating local transportation.

Read More |  View Comments

Share on LinkedIn

Executive Order Aims to Modernize Medicare

October 10, 2019 | Medicare | Comments
Image related to this article

Malka Berro

Policy Associate

Last week, President Trump issued an Executive Order directing the Department of Health and Human Services (HHS) to advance a series of changes for the Medicare program. These changes aim to provide more health plan options for Medicare beneficiaries, modify Medicare fee-for-service (FFS) payments, and reduce regulatory burden, among others.

Read More |  View Comments

Share on LinkedIn

Health Groups Convene Briefing on Medicare Out-of-Pocket Caps

June 27, 2019 | Drug Pricing | Medicare | Comments
Image related to this article

Wendolyn Ebbert

Intern, Policy & Practice Improvement

On Tuesday, the MAPRx Coalition, which includes the National Council, hosted a Congressional staff briefing featuring a panel of advocates representing the AIDS Institute, the American Cancer Society, the National Council on Aging and Avalere Health. Speakers provided an overview of how Medicare Part D offers access to prescription drugs and the need for legislation that would place a cap on out-of-pocket costs for these medications. Currently, costs for medications that treat life-threatening illnesses such as cancer, HIV/AIDS, autoimmune diseases, which often co-occur with mental illness and substance use disorder, amount to tens of thousands of dollars per year per person. If Congress does not act, these expenses are set to increase in 2020, having a devastating impact for over 1 million Medicare enrollees.

Read More |  View Comments

Share on LinkedIn

Congress Seeks to Address Rising Health Care Costs

May 30, 2019 | Drug Pricing | Medicare | Comments
Image related to this article

Shelley Starkey

Both the House and Senate have released bipartisan proposals in the last week to lower out-of-pocket health care costs across the country. The Senate Health, Education, Labor, and Pensions (HELP) Committee has released a sweeping proposal to address surprise medical billing, increase transparency within the health care industry, and bring down drug costs. Meanwhile, leaders of the House Ways and Means and Energy and Commerce Committees are seeking input on draft legislation to cap out-of-pocket costs under Medicare Part D, the program’s prescription drug benefit.

Read More |  View Comments

Share on LinkedIn

Finalized Rule from CMS Preserves Medicare’s Six Protected Classes

Image related to this article

Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) released a final rule on Thursday aimed at addressing rising drug prices and out-of-pocket expenses under Medicare Part D and Medicare Advantage. Notably, the final rule did not include previously-proposed measures that would have provided exceptions to Medicare’s “six protected classes,” a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The announcement comes after six months of opposition to the proposals from Members of Congress and patient and provider advocates, including the National Council for Behavioral Health.

Read More |  View Comments

Share on LinkedIn

New Legislation Enhances Medicare Mental Health Workforce

January 31, 2019 | Medicare | Workforce | Comments
Image related to this article

Michael Petruzzelli

, National Council for Behavioral Health

New bipartisan legislation in the House and Senate would create greater access to mental health care, particularly for rural areas. The bill – the Mental Health Access Improvement Act (H.R. 945/S. 286) – would allow marriage and family therapists (MFTs) and licensed mental health counselors to directly bill Medicare for their services. Similar legislation has been introduced in previous sessions of Congress and again has the strong support of the National Council.

Read More |  View Comments

Share on LinkedIn

CMS Releases 2020 Medicare Advantage and Part D Draft Call Letter

Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

On Thursday, the Centers for Medicare and Medicaid Services (CMS) released its Medicare Advantage (MA) and Part D draft call letter for 2020, which outlines changes to Medicare plan policies and payments each year.

Read More |  View Comments

Share on LinkedIn

CMS Urges Efforts to Improve Care for Dually Eligible Population

January 3, 2019 | Medicaid | Medicare | Quality | Comments
Image related to this article

Michael Petruzzelli

, National Council for Behavioral Health

Late last month, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sent a letter to state Medicaid directors describing ways states can improve care and reduce burdens for individuals who are dually-eligible for both Medicare and Medicaid. This population of individuals tends to have complex medical and behavioral health needs and accounts for a disproportionate share of federal spending for both programs. The letter outlines ten opportunities for states to improve care for the dually-eligible population in 2019.

Read More |  View Comments

Share on LinkedIn

CMS Finalizes Changes to Medicare Quality Payment Program

December 6, 2018 | Medicare | Quality | Comments
Image related to this article

Mindy Klowden

Director,Training and Technical Assistance

The Centers for Medicare and Medicaid Services (CMS) recently issued final policy changes for Year 3 (2019) of the Quality Payment Program (QPP), as part of the final 2019 Medicare Physician Fee Schedule rule. The final rule updates payment rates and key policies applicable to physicians and other professionals under Medicare. Most notably, the rule expands the types of clinicians (including clinical psychologists) that are eligible to participate in the QPP through the Merit-based Incentive Payment System (MIPS).

Read More |  View Comments

Share on LinkedIn

CMS Finalizes Changes to Medicare Physician Payment and Quality Policies

November 8, 2018 | Medicare | Quality | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the 2019 payment year under Medicare. The rule finalizes policies around reducing provider burden, increasing electronic health record (EHR) interoperability, coverage expansions for telehealth, virtual care, and substance use disorder treatment. Notably, CMS decided to modify its original proposal to significantly change the payment and documentation requirements for traditional outpatient, office-based visits by modifying some elements to address concerns raised by provider groups like the National Council and other stakeholders.

Read More |  View Comments

Share on LinkedIn

National Council Submits Comments on Medicare Physician Fee Schedule Rule

September 13, 2018 | Medicare | Workforce | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

This week the National Council for Behavioral Health submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes supported by the National Council were initiatives to reduce billing documentation requirements for Evaluation and Management (E/M) services, base reimbursement for office visits on the level of medical decision-making required, allow for same-day visits and create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

Read More |  View Comments

Share on LinkedIn

CMS Proposes Overhaul of ACO Program

August 16, 2018 | Medicare | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

CMS is planning significant changes to a value-based payment model known as Accountable Care Organizations (ACOs) in a sweeping rule proposed last week. The rule would give new ACOs just two years before they must start sharing savings and losses with the agency. The proposal has drawn criticism from hospital groups and ACO stakeholders, who say the plan will cause many ACOs to leave the program. Comments on the proposed rule are due by October 16, 2018.

Read More |  View Comments

Share on LinkedIn

CMS Proposes Overhaul of Medicare Billing Standards

July 19, 2018 | Medicare | Quality | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

Last week, the Centers for Medicare and Medicaid Services (CMS) released its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes, the proposed rule would reduce billing documentation requirements, expand telehealth options and potentially create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

Read More |  View Comments

Share on LinkedIn

Senate Committees Moving on Opioid Legislation

Image related to this article

Shelley Starkey

Following an action-packed week for opioid-related legislation in the House, multiple Senate committees took up the mantle this week, hosting hearings, releasing new bills and considering legislation ahead of the Memorial Day recess. As bills advance out of committees, the full Senate is expected to consider the large package of opioid legislation later this summer. Meanwhile, similar efforts in the House are expected to make it to the floor in the coming weeks. The collective work of both chambers of Congress seek to address the opioid crisis from a number of fronts including prevention, treatment and recovery.

Read More |  View Comments

Share on LinkedIn

Ways & Means Advances Bipartisan Opioid Proposals

Image related to this article

Samantha Sears

Behavioral Health Policy and Practice Intern

The House Committee on Ways & Means Wednesday approved seven bipartisan bills aimed at reducing opioid misuse and abuse in Medicare. The package would expand Medicare coverage of medication-assisted treatment (MAT), promote non-opioid alternatives for pain management and require Part D plans to have drug management plans for Medicare beneficiaries at risk of opioid addiction. The bills now move to the House floor, joining dozens of other opioid-related bills approved by the House Energy and Commerce Committee.

Read More |  View Comments

Share on LinkedIn

CBO Releases Economic Outlook, Future Health Care Spending Report

April 19, 2018 | Federal Budget | Medicaid | Medicare | Comments
Image related to this article

Samantha Sears

Behavioral Health Policy and Practice Intern

The Congressional Budget Office (CBO) projects the country’s annual budget deficit will reach $1 trillion by 2020 in a new report released this week. The annual report was delayed this year to incorporate analysis on the impact of the Tax Cuts and Jobs Act passed in late 2017. The report highlights not only growing deficits but also growing health care spending for programs like Medicare, Medicaid and social safety net programs.

Read More |  View Comments

Share on LinkedIn

CMS Finalizes Medicare Changes, Tightens Opioid Policies

April 12, 2018 | Medicare | Comments
Image related to this article

Katiri Zuluaga

Manager, State Initiatives

The Centers for Medicare and Medicaid Services (CMS) released final rules for Medicare Part D and Medicare Advantage (MA) plans for calendar year 2019 that are meant to tackle the opioid crisis and decrease drug costs. The CY19 Rate Announcement and Call Letter represents CMS’ priorities for the next year, and will implement new requirements on opioid prescribing and monitoring, require lower co-payments for prescription drugs under Part D, increase availability to generics and, hopefully, decrease costs for consumers and the federal government.

Read More |  View Comments

Share on LinkedIn

Capitol Hill Briefing Highlights Adding MFTs and Counselors to Medicare

March 14, 2018 | Medicare | Workforce | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

On Thursday, the National Council for Behavioral Health, on behalf of the Medicare Access Coalition, hosted two congressional staff briefings on improving Medicare to better serve seniors with mental illness. The briefing featured community mental health professionals from Peak Wellness Center, who shared the challenges they face in finding Medicare-eligible providers to treat their older adult clients. The event highlighted pending bipartisan legislation that would expand the mental health workforce by adding marriage and family therapists (MFTs) and licensed professional counselors (LPCs) to the Medicare program.

Read More |  View Comments

Share on LinkedIn

CMS Proposes Medicare Changes to Address Opioids

Image related to this article

Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) have released its proposed changes to Medicare Advantage and Part D plans for 2019, which include a few provisions to combat the opioid crisis. These changes come in reaction to the soaring opioid prescription and substance use disorder rates among Medicare beneficiaries. CMS is accepting public comments through March 5, and will publish its final rule on April 2.

Read More |  View Comments

Share on LinkedIn

Senate Approves Azar as HHS Secretary

January 25, 2018 | ACA | Medicaid | Medicare | Comments
Image related to this article

Stephanie Pellitt

, National Council for Behavioral Health

The Senate voted to confirm former pharmaceutical executive Alex Azar as the new Secretary of Health and Human Services (HHS) on Wednesday. Six Democrats and Independent Sen. Angus King (I-ME) joined all but one Republican Senator in supporting Azar. As the nation’s top health official, Azar will oversee critical health programs like Medicaid and Medicare and take over the implementation of the Affordable Care Act (ACA). Azar’s confirmation gives HHS its first permanent leader since September, when former Secretary Tom Price resigned due to a scandal regarding his use of public funds for travel.

Read More |  View Comments

Share on LinkedIn
1 2 3 5