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Medicare

The Medicare program, run by the Centers for Medicare and Medicaid Services (CMS), provides health insurance to the aged, disabled, and individuals who have end stage renal disease (ESRD).  Medicare, however, also plays a special role funding Graduate Medical Education (GME) at teaching hospitals. 

Medicare Disproportionate Share (DSH) payments compensate certain hospitals for the higher operating costs they incur in treating a large share of low-income patients, which teaching hospitals do. These hospitals often face substantial financial pressure, as they may provide significant amounts of care to the poor and lack the revenue needed to underwrite the costs associated with the provision of services.

Other areas of Medicare of interest to teaching hospitals and physicians include:


News and Updates


CMS Finalizes Formulary Requirements for Medicare Advantage and Part D Plans

May 17, 2019

The Centers for Medicare and Medicaid Services (CMS) May 16 issued a final rule allowing Medicare Advantage (MA) and Part D plans to utilize step therapy and prior authorization for drugs in six drug categories (“protected classes”) and for some Part B drugs [see Washington Highlights, Nov. 30, 2018]. The rule also includes the requirement for Part D plans to implement an electronic real-time benefit tool (RTBT) to make available beneficiary-specific drug coverage and cost information to prescribers. Plans will also be required to include negotiated drug pricing information on the Explanation of Benefits (EOB).


AAMC Hosts GME Day of Action, Congressional Briefing

May 10, 2019

The AAMC May 6 hosted a Graduate Medical Education (GME) Day of Action in conjunction with the GME Advocacy Coalition — a group of hospital, physician, academic, and specialty stakeholder organizations — which it convenes. The Day of Action was designed to raise the profile of Medicare-supported GME, which has been effectively frozen since 1997, and to urge members of Congress to co-sponsor the Resident Physician Shortage Reduction Act (S. 348/H.R. 1763) [see Washington Highlights Feb. 8, March 15].


CMS Releases Final Rule on Drug Price Transparency

May 10, 2019

The Centers for Medicare and Medicaid Services (CMS) May 8 released a final rule requiring drug manufacturers to disclose drug prices in direct-to-consumer (DTC) television advertisements. This follows the Oct. 15, 2018, publication of the proposed rule [see Washington Highlights, Oct. 19, 2018].


CMS Issues Draft Guidance on Hospital Co-Location Requirements

May 10, 2019

The Centers for Medicare and Medicaid Services (CMS) May 3 issued draft guidance addressing hospital co-location requirements under the Medicare Conditions of Participation (CoPs). 


House Committees Continue to Review Prescription Drug Prices

May 3, 2019

The House Energy and Commerce Health Subcommittee and House Judiciary Committee both held hearings April 30 on rising prescription drug costs.


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