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News & Press: Government Affairs News

Administration Drops Part B Demo

Friday, December 16, 2016   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Washington, DC - The Obama Administration, as it is wrapping up its work before leaving office, has declined to finalize the oft-criticized Medicare Part B Drug Payment Model, according to Politico. A CMS spokesperson told the newspaper that "while there was a great deal of support from some, a number of stakeholders expressed strong concerns about the model. While CMS was working to address these concerns, the complexity of the issues and the limited time available led to the decision not to finalize the rule at this time."

Reaction on the Hill was swift with House Minority Leader Nancy Pelosi (D-CA) praising CMS' decision not to finalize the proposed rule.

The demonstration model would have cut CMS' payments for drugs provided to a Medicare beneficiary by a physician and billed under Part B. One of the proposals in the rule was to lower payment for these medications from 6% of the drug's average sales price to 2.5% and adding a flat payment of $16.80 per drug, per day. Medical providers were concerned with this and other proposals arguing that they could force patients to higher cost care settings or force patients to go without treatment due to the high cost.

The rule could still be finalized by the Trump administration by it is unlikely that President-Elect Donald Trump will continue this particular policy of his predecessor. The model was created by the Centers for Medicare and Medicaid Innovation (CMMI) which has been directed to lower the cost of healthcare in the United States through innovative payment policies.

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