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Medicare and Medicaid News

Medicaid Expansion Waiver Secured in Michigan

A waiver needed to continue Medicaid coverage for 600,000 low-income adults beyond April was secured in December. The program, known as "Healthy Michigan" has some features unique to Michigan, including requiring adults with incomes 100%-130% of poverty level who have been enrolled for four years to engage in healthy behavior or buy private insurance through the federal exchange, or pay higher copays and contribute more to health savings accounts. The waiver goes into effect in April 2018, and applies to about 100,000 adults; however, if not passed, the full 600,000 people would have lost coverage.

Patient Access and Medicare Protection Act Now Law

The Patient Access and Medicare Protection Act has been signed into law by President Obama, a law that includes a number of Medicare provisions not previously included in the Consolidated Appropriations Act. The Patient Access and Medicare Protection Act revised the fee schedule for physicians who deliver radiation treatment and related imaging services, extended the timeframe for eligible hospitals and providers to apply for a hardship exemption from meaningful use penalties, and several other requirements.

Resource Guide and Contact List for ICD-10 Questions

The Center for Medicare and Medicaid Services (CMS) released a Resource Guide and Contact List, which provides contact information for questions relating to ICD-10 and Medicare and Medicaid. Click here to view the Provider Contacts for Medicare and Medicaid Questions table.

CMS Mandates Prior Authorization for Durable Medical Equipment

The Center for Medicaid and Medicare Services (CMS) issued a final rule mandating that authorization for some durable medical equipment prosthetics, orthotics, and supplies, (DMEPOS) is needed earlier in the process. Typically, mobility devices such as motorized wheelchairs can cost up to $5,000, with Medicare paying up to 80% of the cost if a physician deems them as necessary. The rule mentions a 2011 report that found that 61% of power wheelchairs in the first half of 2007 were medically unnecessary or lacked sufficient documentation to determine medical necessity. The final rule includes a list of 135 products that are frequently found to be the subject of unnecessary utilization.

CMS Reforms Rebate and Reimbursement System for Medicaid Rx

A new rule finalized by the Center for Medicaid and Medicare Services (CMS) reforms the rebate and reimbursement system for Medicaid prescription drugs. The final rule, "Covered Outpatient Drugs" provides more detail on how rebates and reimbursements are calculated in an effort to help ensure affordable and accessible prescription drugs to Medicaid beneficiaries. CMS Deputy Administrator and Director for the CMS and CHIP Services says, "This final rule makes changes that will save taxpayers billions and ultimately improve beneficiary access to prescription drugs."