August 14, 2020

Around the nation: CMS wants to change Medicare coverage for artificial hearts, ventricular assist devices

Daily Briefing
    CMS is proposing to allow local Medicare Administrative Contractors to make coverage determinations related to artificial hearts, in today's bite-sized hospital and health industry news from California, Kentucky, and Maryland.
    • California: Kaiser Permanente on Monday announced it will donate $63 million to the Public Health Institute in Oakland to create contact tracing teams in communities seeing high numbers of coronavirus cases. The teams will support local public health departments but operate through Kaiser's clinical settings. Each team will include eight contact tracers, a supervisor, and a resource coordinator (Anderson/Smith, Sacramento Bee, 8/11).

    • Kentucky: Humana on Monday filed a lawsuit in the U.S. Court of Federal Claims against the federal government, claiming that the federal government failed to pay the insurer about $2 million in cost-sharing reduction (CSR) subsidies that the company says it is owed under the Affordable Care Act (ACA). Humana in the suit argued that the federal government is obligated under the ACA to pay the subsidies for exchange plans the insurer sold in 2017. Numerous health insurers—including Anthem, Cigna, and Harvard Pilgrim—have filed similar lawsuits (Livingston, Modern Healthcare, 8/11).

    • Maryland: CMS on Wednesday proposed updates to Medicare's coverage policy for artificial hearts and ventricular assist devices for patients with advanced heart failure. Under the proposed changes, Medicare would no longer cover artificial hearts under a "coverage with evidence development" paradigm, which currently requires that patients be enrolled in clinical studies for Medicare to cover the devices. Instead, local Medicare Administrative Contractors would make coverage determinations related to artificial hearts. In addition, CMS said the proposal would update national coverage criteria for ventricular assist devices to better align with medical practice. CMS currently is accepting public comments on the proposal and intends to issue a finalized update within the next 90 days (Hackett, Healthcare Finance News, 8/12; Brady, Modern Healthcare, 8/12; Haefner, Becker's Hospital Review, 8/12).
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