Medicare & Medicaid

Republican Iowa Governor Terry Branstad has announced expanded Medicaid coverage for eligible residents in his state through a program he is calling Medicaid modernization.

CMS instead wants to establish set payment amounts, indicating the bid process lacks competition, and therefore, price incentives.

Arkansas Gov. Asa Hutchinson said Wednesday that federal officials have approved most of his requested changes to the state's Medicaid expansion program and urged the legislature to continue it.

The Centers for Medicare and Medicaid Services on Friday released proposed changes for the Medicare Advantage and Part D prescription drug programs for 2017, including an increase in the net payment rate for Medicare Advantage of 1.35 percent, CMS said.

Medicare beneficiaries who live in urban areas may save money on their prescription drugs this year because they have better access to pharmacies in drug plan networks that charge lower copayments or coinsurance, according to the federal Centers for Medicare & Medicaid Services.

The state last week won federal approval to shift most of its Medicaid recipients into managed care organizations, which are paid a fixed monthly fee from the state for each person in the plan. It's a strategy employed by about three dozen states, many for decades, to provide more predictable spending.

A new report from the Center for Improving Value in Health Care reveals significant variation in payments in Colorado for hip and knee replacements between private health insurance payers and Medicare: Coloradans with private insurance in the northeast pay $55,000 more than their neighbors with Medicare, while those in Denver pay $17,000 over Medicare prices.

The Centers for Medicare and Medicaid Services has announced access to preferred cost-sharing pharmacies has improved, with the bottom 10 percent of plans so far this year offering access within two miles of 71 percent of urban beneficiaries. That's compared to 40 percent of beneficiaries who had similar geographic access in 2014.

The Centers for Medicare and Medicaid Services on Thursday published a final rule that requires healthcare providers to repay overpayments discovered within six years of the initial Medicare reimbursement, a significantly shorter lookback period than first proposed.

In December 2014, Medicare began a pilot program in three states, including Pennsylvania, to cut down on what officials believed were improper payments, including some possible fraud and abuse, in nonemergency ambulance services. The program moved to more aggressively enforce Medicare's long-standing policy requiring that beneficiaries be so weak they could only be moved on a stretcher before it would pay for repeated, nonemergency ambulance service.