HHS secretary nominee Sylvia Mathews Burwell should promise not to implement proposed changes to Medicare Part D that were introduced in January, write Douglas Holtz-Eakin and Angela Boothe of the American Action Forum. "Seniors deserve reassurance from Ms. Burwell that their choices will not be limited, their costs will not increase, and that they will continue to receive the cost-sharing benefits provided by a preferred pharmacy," they write.
The Medicare Payment Advisory Commission voted to recommend that Congress add a hospice benefit for Medicaid Advantage, but the change could allow for potential cost-sharing that could limit patient access to certain hospices. Current rules allow some MA plan members to elect a palliative care benefit through Medicare's fee-for-service program. MedPAC also will call for penalties for home health care providers with high hospital readmission rates.
With a bill under consideration in the House that would replace Medicare's sustainable growth rate formula, Congress is looking at some strategies that could help address the projected $140 billion gap that will open if the SGR is repealed. Proposed measures include altering the enrollee cost-sharing structure and post-acute care framework. Those changes are said to be capable of generating nearly $113 billion in savings, but some lawmakers want other options considered.
Lawmakers in the Senate and House have introduced the Supporting ColoRectal Examination and Education Now Act to eliminate Medicare cost-sharing in cases where polyps are removed during a screening colonoscopy. ACG President Dr. Ronald J. Vender said the cost-sharing "undermines the intended purpose of the procedure — to prevent cancer from developing in the first place."
Final rules on essential health benefits under the Affordable Care act clarify cost-sharing for colonoscopy. The guidance stipulates that private insurers cannot impose patient cost-sharing for any polyp removal during recommended colorectal cancer screenings, which are fully covered.