Payer Roundup—Grassley calls on HHS, CMS to explain inflated lab spending

Grassley's letter follows a recent report from the Government Accountability Office which found that changes made by the Centers for Medicare & Medicaid Services (CMS) to establish a national fee schedule for laboratory services may have resulted in hundreds of millions of dollars in increased payments. (Getty/RossHelen)

Grassley calls for answers on lab fees

Senate Finance Committee Chairman Chuck Grassley, R-Iowa, is calling for the Department of Health and Human Services to explain the potential for a big increase in costs to Medicare for laboratory services. 

Grassley's letter follows a recent report from the Government Accountability Office which found that changes made by the Centers for Medicare & Medicaid Services (CMS) to establish a national fee schedule for laboratory services may have resulted in hundreds of millions of dollars in increased payments because it used a maximum payment rate as a baseline instead of an average payment.

The report also found that Medicare changed the way it processed some laboratory tests and often paid an individual rate for panel tests instead of a lower, bundled rate, which could cost more than $10 billion. (Letter)

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MACPAC: Providers are less likely to take Medicaid compared to other insurance

Providers are less likely to take new patients who are insured by Medicaid compared to patients who have other forms of insurance, according to a new report commissioned by the Medicaid and CHIP Payment and Access Commission. 

About 71% of providers were likely to accept patients insured by Medicaid compared to 85% of those on Medicare or 90% of those with private insurance. About 68% of physicians in family practice were likely to accept new patients on Medicaid compared to 90% who would accept patients on Medicare and 91% who would accept new patients with private insurance. Pediatricians accepted new Medicaid patients at a lower rate (78%) compared to about 91% who would take new privately insured patients.

The difference was more pronounced among psychiatrists, who accepted new Medicaid patients at a rate of about 36% compared to 62% who would accept new Medicare patients or private insurance. (Report

Washington seeks novel hep C drug pricing with winner-take-all bidding

Just weeks after Louisiana announced a plan to tackle hepatitis C by purchasing drugs in a Netflix-style subscription model, officials in Washington said they are upping the ante with their own winner-take-all contract.

In the “winner take all” deal, Washington would pay a flat fee to open up hepatitis C treatment across four state agencies, including all of its Medicaid beneficiaries and prisoners, and employees covered by the state health plan, FiercePharma reported.

In a request for proposals, Washington asked that bidders include details on outreach and screening as well as drug pricing. The winning deal could be worth about $600 million, given a price of $20,000 per drug course, Bernstein analyst Ronny Gal wrote in a Monday note. About 30,000 patients would have access to treatment through the initiative. (FiercePharma)

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