Dozens of
governors at a recent closed-door meeting in Washington posed scores of
unanswered policy questions related to the health law's Medicaid expansion and
insurance exchanges and expressed frustration that they can't fully assess
their options until they get answers from CMS, according to a summary of the
July 19-20 meeting. In addition to the more obvious Medicaid expansion
questions left unclear by the high court's ruling, the governors also sought
clarification of dozens of issues linked to the intricacies of exchange
implementation, resolution of which could determine whether some move forward
with state exchanges or defer fully or partially to the federal exchange
option.845 words
The House
Energy and Commerce health subcommittee chair and ranking Democrat are
circulating a dear-colleague letter that urges CMS to scrap plans to
significantly cut Medicare pay for cancer radiation services at freestanding
clinics. The American Society for Radiation Oncology (ASTRO) has kicked off a
campaign against the cuts with a survey of its members, many of whom say they
will either go out of business or accept fewer Medicare patients if the
proposed pay cuts go through.669 words
Key details
of a ground-breaking public-private partnership to fight health care fraud
unveiled by HHS and insurers Thursday (July 26) are unclear as working groups
continue to work out how the program will be structured and develop a draft
initial work plan. Under the National Fraud Prevention Partnership, claims data
will be shared among major insurance companies, the federal government and other
partners in a bid to pinpoint fraud schemes that may not be detectable by a
single payer. A congressional aide says the program could hold promise, but a
state Medicaid source suggests that HHS' apparent failure to include Medicaid
agencies in the initiative is problematic.732 words
HHS Secretary
Kathleen Sebelius met privately with hospital groups earlier this week and
urged them to convince states to move ahead with the reform law's Medicaid
expansion, but the administration didn't say whether the law's hospital payment
cuts would apply in states that do not expand Medicaid, a hospital lobbyist
tells Inside Health Policy. HHS appears to understand hospitals'
concerns about the hospital payment cuts going forward in states that opt
against expanding Medicaid, but the administration also doesn't want to reward
states that choose to forgo it, the lobbyist says.785 words
HHS is doing
the first round of testing related to the federal exchange with states and
insurance carriers and the department will soon provide states with a federal
exchange implementation schedule, CCIIO Interim Director Mike Hash said Friday
(July 27). The agency will also issue additional guidance on the federal
exchange and partnership model later this summer that is focused on federal
exchange operational details, he said.470 words
As HHS
prepared to showcase a new anti-fraud Command Center Tuesday, Senate Finance
Republicans Orrin Hatch (UT) and Tom Coburn (OK) challenged CMS to justify the
need for the center and its expense given what they say is a lack of data to
evaluate the new predictive analytics approach to stemming fraud. The lawmakers
wrote to CMS Acting Administrator Marilyn Tavenner that the dearth of specifics
about how the agency gauges the success of its Fraud Prevention System is
disappointing, and leaves Congress to rely on "impressionistic anecdotes and
unnuanced claims" from HHS.1004 words
The
Congressional Budget Office estimates that freezing doctors' Medicare pay rates
would cost the government $271 billion over 10 years, which is the same as
CBO's March estimate and far less than the Office of Management and Budget's
estimate last week of $395 billion, even though that OMB estimate was some $35
billion under it's previous projection.149 words
Kansas
Insurance Commissioner Praeger said some believe that an elected state
insurance commissioner may be able send a letter declaring what the state plans
to do with its exchange, but added that she doesn't believe it would be wise to
take that action since her state's governor and legislature are opposed to the
health reform law. HHS had previously said that the state's governor must send
in the declaration of intent to run the exchange, but several states have
suggested that an elected insurance commissioner should be able to confirm a
state's decision to run the plan management function since that regulatory work
falls under their jurisdiction. HHS is reviewing the stakeholder comments and
will be issuing a final Exchange Blueprint draft application shortly.536 words
Arizona as
part of its duals demonstration aims to place all 120,000 dually eligible
beneficiaries who are already enrolled in Medicaid managed care plans into
Medicare Advantage special needs plan (D-SNP) operated by the same insurer in
order to better coordinate care for the vulnerable duals population, and state
and insurance officials point to a recent Avalere study to underscore the care
improvement and cost-savings potential that such an approach offers. The
findings suggest that policymakers should take a closer look at the model, says
Avalere senior vice president Bonnie Washington.602 words
As Democrats
celebrate the health reform law's requirement that many insurance plans
starting Wednesday (Aug. 1) must cover several preventive services for women
without cost-sharing, questions remain on the administration's "accommodation"
on contraceptive coverage for religious organizations that self-insure, with
such entities recently indicating that the way the administration is trying to
resolve the issue is not viable and may clash with ERISA.754 words
CMS featured
a CMS Command Center for fighting health care fraud on Tuesday (July 31) with
real-time demonstrations of the system's predictive analytics capabilities. HHS
Secretary Kathleen Sebelius toured the facility ahead of what one health care
specialist called a significant report on the predictive analytics program,
which is expected to be released in the fall.543 words
Wisconsin's
top health official says he expects there to be litigation if HHS doesn't budge
on the controversial Medicaid maintenance of effort requirements, telling Inside
Health Policy that attorneys in his state disagree with a recent finding by
the Congressional Research Service and signals from HHS that the MOE
requirements remain intact despite the high court's ruling that states can opt
out of the health law's Medicaid expansion. The statement comes in the wake of
reports that Maine Gov. Paul R. LePage is planning to cut thousands of people
from his state's Medicaid rolls, directly confronting the MOE issue.966 words
FDA filed
court papers defending statements the agency made over the past year and half
regarding its enforcement discretion toward compounded versions of KV
Pharmaceutical's pre-term labor drug Makena, saying court-mandated enforcement
against compounders would not necessarily influence reimbursement policies and
as a result the company's case against the agency is null. In response to the
company's lawsuit -- which also touches on FDA's orphan drug and importation
policies -- FDA argues that its decision against taking enforcement action is
not reviewable by the courts.598 words
KV
Pharmaceutical is suing two state health agencies over Medicaid prior
authorization procedures that the company says are illegally blocking access to
its pre-term labor drug Makena in favor of a cheaper compounded version of the
drug, with cases in Georgia and South Carolina coming after the company
recently sued FDA. The company filed suits against FDA and the states after
recent FDA and CMS statements failed to sway state Medicaid agencies to
coverage the branded drug instead of compounded copies. If the company's
financial situation does not improve, it could go out of business in as little
as two months, it says in court documents.656 words
The Office of
Management and Budget's estimated 10-year cost of repealing the Medicare
physician payment formula has dropped by $35 billion, from $429 billion down to
$395 billion, over 10 years, as a result of lower utilization numbers that also
impacted overall Medicare spending projections. Additionally, the $362 billion
in savings that had been expected from health care policy changes proposed in
the president's budget has dropped down to a projected $324 billion in savings.373 words
The
collection of patient registries developed by the Agency for Healthcare
Research and Quality could bolster comparative effectiveness research by
allowing analysis of patient outcomes beyond typical postmarket surveillance, a
researcher involved with the project said. The registry project could also
accelerate rare disease research by centralizing information available about
patient populations and natural history studies, according to rare disease
patient advocates and an official at the National Institutes of Health.943 words
The White
House Office of Management and Budget will begin meeting with federal agencies
to discuss plans for implementing cuts mandated by sequestration and
identifying programs that could be exempt from the automatic cuts set to take
effect Jan. 2, the Obama Administration states in a memo to agency heads
Tuesday (July 31), while also pressing Congress to "redouble its efforts" to
reduce the deficit and avoid sequestration. But OMB also notes that final
sequestration numbers cannot be calculated until fiscal 2013 funding levels are
known and urges agencies to continue current spending patterns for now.673 words
Pharmacists
and small distributors are pressing lawmakers not to pursue legislation that
would prohibit wholesalers from purchasing prescription drugs from pharmacies,
saying such purchases are a legitimate practice that could be used to alleviate
temporary drug shortages. Secondary distributors -- which do not typically
purchase their drugs directly from manufacturers -- have been the focus of
investigations into the gray market where drugs are passed from pharmacies to
distributors and marked up each time. Pharmacists may get some backing from GOP
members, as a Republican staff memo, obtained by Inside Health Policy,
contends that the gray market offers a "legitimate and necessary service" in
some cases and a GOP lawmaker said the gray market issue should instead be
addressed by state boards of pharmacy.1287 words
CMS Deputy
Administrator for Program Integrity Peter Budetti says the agency's new
anti-fraud Command Center will pay for itself many times over, despite Senate
Finance Committee Republicans' concerns that the agency's new predictive
analytics hub, which pulls together all aspects of the agency's program integrity
efforts, may not be necessary.706 words
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