CMS Pushes Back Controversial Radiation Oncology Model Leave a comment

Modern Healthcare says radiation oncologists oppose the model’s design, and the Center for Medicare and Medicaid Innovation wants to test whether it will save money. Under the new federal government rule, once a decision is made CMS must propose a new start date 6 months ahead.

Modern Healthcare: Radiation Oncology Model Indefinitely Delayed
The federal government indefinitely delayed the start of the controversial radiation oncology model in a final rule published Thursday. The Centers for Medicare and Medicaid Services will propose a new start date at least six months in advance under the final rule. CMS proposed the extended delay in April after the agency and Congress pushed its start date back several times. The model was originally slated to roll out Jan. 1, 2021. … The Center for Medicare and Medicaid Innovation, which will manage the mandatory initiative, wants to test whether prospective, site-neutral, episode-based payments for radiotherapy can save money. (Goldman, 8/25)

In other health care and insurance news —

Modern Healthcare: DOJ Joins Cigna Medicare Advantage Fraud Case
The whistleblower lawsuit, filed in 2017 in a New York federal court by a former service provider for Cigna’s Medicare Advantage subsidiary HealthSpring, accuses Cigna of bilking the federal government out of $1.4 billion by submitting improper diagnostic codes from 2012 to 2019. The codes were allegedly based on health conditions that did not exist in the patient or were not found in any medical record. (Kacik, 8/25)

Modern Healthcare: California Medicaid Contracts With Molina, Centene, Elevance
California regulators intend to award coveted five-year Medicaid managed care contracts to Molina Healthcare, Centene subsidiary Health Net and Elevance Health’s Anthem Blue Cross Partnership Plan, the state Department of Health Care Services announced Thursday. (Tepper, 8/25)

Modern Healthcare: Centene Washington State Medicaid Fraud Case Settled 
Centene will pay $33 million to settle allegations its now-defunct pharmacy benefit manager overcharged the Washington state Medicaid program for drugs. (Tepper, 8/25)

Tampa Bay Times: Florida Blue, BayCare Spar Over Health Care Coverage
Tens of thousands of Tampa Bay residents may have to find new doctors by October as two of the region’s major health care players are publicly sparring over a new insurance contract. (O’Donnell, 8/25)

Stat: Why Amazon And Others Are In A Bidding War For Home Health Tech 
The bidding war over Signify Health — a health technology business that could fetch multibillion-dollar offers from Amazon, CVS, and UnitedHealth Group — is not about its dazzling software or a blockbuster AI algorithm. The crush of corporate interest, experts said, stems from something much bigger: the opportunity to move medical services back into the home. (Ross and Palmer, 8/25)

Also —

Becker’s Hospital Review: 10 States With Highest Coding Rates For Social-Determinants-Of-Health Diagnoses
The most used codes were those for homelessness; disappearance and death of family members; problems related to living alone; problems related to living in a residential institution; and problems in relationship with a spouse or partner. (Cass, 8/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.


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