Medicare faces cost tension with lawmakers, advocates

Jun 19 2014

CMS must decide how it will handle certain tests and medicines.

The Associated Press: Lawmakers Urge Medicare Cover Cancer Test
More than 130 lawmakers are urging the Obama administration to expand coverage for a lung-cancer test under Medicare that could cost the program billons, calling the screening important for vulnerable seniors. In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer. ... A CMS spokesman said the agency's decision will be based on whether the test is "reasonable and necessary," without regard to its cost to Medicare (Yen, 6/17).

The Hill: Advocates Blast 'Prior Authorization' For Hospice Drugs
Hospice programs and workers are urging the Obama administration to suspend rules they say are limiting patients' access to necessary medications at the end of life. During a lobby day on Capitol Hill, more than 240 advocates called on Medicare to withdraw a new "prior authorization" process for drugs used for hospice patients. ... The agency reasoned that "prior authorization" would help to ensure the correct division of Medicare was paying for each prescription. Hospice care and related medications are covered under Part A, while other drugs fall under Part D (Viebeck, 6/17).

The CT Mirror: 'Observation Status:' The Term Hospital Patients Should Know
Patients, take note: Starting Oct. 1, those who spend more than 24 hours in the hospital could receive notice that they've been placed on something known as "observation status." It's a technical term, but one that could mean the difference between having their recovery paid for -- or ending up with a hefty bill. The notice is required under a new state law Gov. Dannel P. Malloy signed last week. It takes effect Oct. 1 (Levin Becker, 6/18).

Related KHN coverage: FAQ: Hospital Observation Care Can Be Costly For Medicare Patients (Jaffe, updated 6/18).