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McDermottPlus Check-Up: December 13, 2019

House Democrats passed a sweeping drug pricing reform package and key House and Senate committees announced a surprise billing deal.

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Health Policy Breakroom: Episode 4, 2020 Changes to the Quality Payment Program

Mara McDermott and Sheila Madhani join Emma Zimmerman to discuss changes in the 2020 changes to the Quality Payment Program and the landscape of Advanced Alternative Payment Models.

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McDermottPlus Check-Up: December 06, 2019

Congress is back in town with just two weeks to address government funding and many healthcare issues. More proposals are emerging on drug pricing and surprise billing, and the House Judiciary Committee took up impeachment.

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McDermottPlus Check-Up: November 22, 2019

Impeachment continued to dominate the news, Congress averted a government shutdown, and federal vaping regulation stalled.

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Health Policy Breakroom: Episode 2, OPPS Prior Auth

Mara McDermott and Jessica Roth join Emma Zimmerman to discuss changes in the 2020 Hospital Outpatient Prospective Payment System final rule related to prior authorization and the landscape of utilization management policy more broadly.

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McDermottPlus Check-Up: November 15, 2019

Government funding negotiations continued against the backdrop of impeachment, and the CMS issued new rules on provider price transparency and Medicaid supplemental payments.

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McDermottPlus Check-Up: November 8, 2019

There was little activity in Congress with the House in recess, but we saw several developments in the Medicaid space including new guidance from the CMS.

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CMS Releases CY 2020 Medicare OPPS and ASC Payment System Final Rule

On November 1, 2019, CMS released the CY 2020 Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment Systems effective for services on January 1, 2020.

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CMS Releases Final Rule for CY 2020 Physician Fee Schedule

On November 1, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, which includes changes related to Medicare physician payment and the Quality Payment Program effective for services on January 1, 2020.

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McDermottPlus Check-Up: November 1, 2019

This Week’s Dose: Drug pricing discussions continued in Congress. The full House and the Senate Health, Education, Labor, and Pensions (HELP) Committee advanced health bills.

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McDermottPlus Check-Up: October 25, 2019

The House Ways and Means Committee completed its markup of H.R. 3, but floor consideration was pushed until mid-November. Seema Verma appeared before the House Energy and Commerce Oversight and Investigations Subcommittee.

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McDermottPlus Healthcare Preview: October 21, 2019

Administrator Verma is testifying, and the debate on prescription drug pricing reforms continues.

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McDermottPlus Check-Up: October 4, 2019

This Week’s Dose: The impeachment inquiry proceedings are still moving forward, despite the Congressional recess. Surprise billing activity continued, and the Trump Administration issued an Executive Order on Medicare.

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McDermottPlus Check-Up: September 6, 2019

The Recess Dose: With the August recess wrapping up, we are back at the McDermottPlus Weekly Check-Up. Here’s what you may have missed over the break.

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McDermottPlus Check-Up: August 2, 2019

This Week’s Dose: Things have quieted down in Congress with the House out of session and the Senate wrapping up its last week before the August recess. But the agencies are still at work, so don’t totally check out just yet.

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McDermottPlus Check-Up: July 19, 2019

This Week’s Dose: The Energy and Commerce Committee held a marathon mark-up of 25 bills, including 10 health care related bills. The No Surprises Act received an amendment that adds arbitration to the payment dispute process. The House voted to repeal the Cadillac tax. And, we finally have a Congressional Budget Office (CBO) score for…

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McDermottPlus Check-Up: June 14, 2019

This Week’s Dose: The focus was back on surprise billing this week with the third hearing of the year. We also saw hearings on Medicare for All and vertical consolidation in the health care industry, and the House advanced an appropriations package.

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McDermottPlus Check-Up: June 7, 2019

This Week’s Dose: Congress is back, and this week marked the start of another busy legislative session. Work continues on drug pricing, surprise billing and cost containment, and negotiations have begun on an extenders package as well.

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CMS Releases Final Rule Aimed at Lowering Drug Prices and Reducing Out-of-Pocket Spending

Since mid-2018, the Centers for Medicare and Medicaid Services has been implementing sections of the American Patients First Blueprint, President Trump’s plan to lower drug prices and reduce patient out-of-pocket spending.

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McDermottPlus Check-Up: May 10, 2019

This Week’s Dose: Another busy week for prescription drug pricing. Two more hearings took place on the subject, and a handful of bills passed out of the House. Now we watch the Senate to see how it packages and advances prescription drug bills that have moved through the House.

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McDermottPlus Check-Up: May 3, 2019

This Week’s Dose: Lots of activity surrounding single-payer this week with a hearing, the introduction of two Medicare expansion bills and a report from the Congressional Budget Office (CBO). Hearings and markups of drug pricing bills continue as well. This legislative session is off to a busy start.

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McDermottPlus Check-Up: April 26, 2019

This Week’s Dose: When Congress is away, the agencies will play. The Administration made some major announcements and dropped several new important rules this week, giving stakeholders plenty to talk about (and work on) while Congress is in recess.

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McDermottPlus Check-Up: April 12, 2019

This Week’s Dose: Drug pricing continues to be the focus in Congress with multiple hearings and markups on the subject. So far, lowering drug prices remains a rare area of consensus among lawmakers.

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McDermottPlus Check-Up: February 22, 2019

This Week’s Diagnosis: It’s all quiet on the Hill. Members return Monday after the first full week of district work time in the 116th Congress.

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McDermottPlus Check-Up: February 15, 2019

This Week’s Diagnosis: Congress passed a $328 billion spending package to avert another government shutdown.  President Trump is expected to sign it.  Congressional hearings continue to focus on coverage and drug pricing.  

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McDermottPlus Check-Up: February 1, 2019

This Week’s Diagnosis: Government reopens…for at least three weeks. Congress is full steam ahead, kicking off the 116th with health care hearings on drug pricing and pre-existing conditions. The US Department of Health and Human Services focuses on 2019 priorities.

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McDermott Plus Check-up: January 25, 2019

This Week’s Diagnosis: Hearings are beginning and priorities are emerging. The shutdown drags on. And updates are trickling out of the Administration.

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McDermottPlus Check-Up: January 18, 2019

This Week’s Diagnoses: Shutdown enters historic territory. Prescription drug costs emerge as a priority issue for the 116th Congress. Committee assignments are almost complete.

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McDermottPlus Check-Up: January 11, 2019

This Week’s Diagnosis: Welcome back – sort of. The partial federal government shutdown drags on. We are on day 21 with no end in sight, which has shifted the focus of the new Congress away from overarching health priorities and toward continued efforts to reopen the government.

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MSSP Final Rule Seeks to Accelerate Move to Performance-Based Risk in Traditional Medicare

On December 31, 2018 CMS published the Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 final rule.

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McDermottPlus Check-Up: December 21, 2018

This Week’s Diagnosis: Time is ticking for any deal to avoid any partial government shutdown. It is the only thing holding up adjournment.

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McDermottPlus Check-Up: December 14, 2018

This Week’s Diagnosis: President Trump clashed with House Democratic Leader Nancy Pelosi (D-CA) and Senate Minority Leader Chuck Schumer (D-NY) in a meeting this week about how to keep the government’s lights on. The President threatened to shut down the government on December 21, when the current short-term funding agreement expires, if his request for…

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McDermottPlus Check-Up: December 7, 2018

This Week’s Diagnosis: Memorial services for President George H.W. Bush were held this week in Washington, DC and Texas. No agreement has been reached on border wall funding, which means Members may be here through at least December 21.

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McDermottPlus Check-Up: November 30, 2018

This Week’s Diagnoses: Welcome back! Members are back in town for a sprint to the finish. Controversy over the House Democratic leadership elections fizzled, with the same faces in the top three positions.

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McDermottPlus Check-Up: November 16, 2018

This Week’s Diagnosis: Newly elected congressional members were welcomed to Washington this week, while currently serving members returned for a brief, but important post-election lame duck session.

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McDermottPlus Check-Up: November 9, 2018

This Week’s Diagnoses: Was the election only four days ago? Tuesday brought change to Congress. While a handful of races have yet to be called, Democrats will take charge of the House of Representatives, while Republicans will retain control of the Senate come January 2019. We have a full breakdown of what the election results…

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McDermottPlus Check-Up: November 2, 2018

This Week’s Diagnosis: While members of Congress are touting the passage of the opioid package on the campaign trail, the Administration continued releasing a series of significant health policy regulations.

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McDermottPlus Check-Up: October 26, 2018

This Week’s Diagnosis: The Administration remains active with the issuance of several new guidance documents, the drug pricing announcement and the President (finally) signing the bipartisan opioid legislation (HR 6).

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McDermottPlus Check-Up: October 19, 2018

This Week’s Diagnoses: All eyes are on the midterm election, now less than three weeks away.  The House and Senate are out; the Administration continues to release health-related regulations and announcements.

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McDermottPlus Check-Up: October 12, 2018

With midterms less than one month away, it is relatively quiet around Washington, DC. The Senate completed its work on Thursday and now joins the House in recess until after the midterm elections.

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Five Key Takeaways: CJR Year 1 Performance Evaluation

A recently released evaluation of the CMS Comprehensive Care for Joint Replacement Model found a statistically significant reduction in spending in both high cost and low cost areas during the first performance year. Here are our five key takeaways.

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Top 5 Takeaways: CMS’s Proposed Overhaul of the MSSP ACOs

On August 17, 2018, CMS released proposed rule that would make sweeping changes to the Medicare Shared Savings Program, a federal program that incentivizes integrated health provider networks to form Accountable Care Organizations. Comments are due October 16, 2018. Our top 5 takeaways follow.

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Top 10 Takeaways: 2019 OPPS/ASC Proposed Rule

On July 25, 2018, CMS released proposed policy and payment updates affecting the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System for calendar year 2019. Read our top 10 takeaways from the rule.

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CMS Finalizes Next Implementation Phase of Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services

Beginning January 1, 2020, when submitting claims to Medicare for advanced diagnostic imaging services furnishing professionals and entities must certify that professionals ordering services consulted AUC applicable to the imaging modality

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CMS Proposes Changes to Medicare Physician Payment in 2019

On July 12, 2018, CMS released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B, which includes proposals related to Medicare physician payment and the Quality Payment Program. Read our top 10 takeaways from the rule here.

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CMS Advances MACRA Medicare Advantage APM Demonstration

The Medicare Advantage Qualifying Payment Arrangement Incentive demonstration would waive Merit-Based Incentive Payment System requirements for clinicians taking sufficient risk in contracts with Medicare Advantage plans. The agency seeks comments on the information collection burdens associated with this demonstration that is under consideration for formal approval. More information on the request for comments is available…

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MACRA Final Rule Released: CMS Establishes 2017 as Transition Year for QPP

CMS finalized policies for 2017 that will offer providers more flexibility and opportunity to meet requirements under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

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