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Daily News

September 17, 2019

A federal judge on Tuesday (Sept. 17) said CMS lacked authority to impose deep reimbursement cuts for clinic visits at certain off-campus facilities.

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Tennessee on Tuesday (Sept. 17) unveiled its proposal to receive much of its federal Medicaid money in the form of a block grant -- a plan that includes requests for a closed drug formulary and significant new freedom from federal regulatory requirements on managed care contracts, optional benefits and how Medicaid funds can be used.

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House Speaker Nancy Pelosi (D-CA) is expected to release her long-awaited government drug price negotiation plan on Wednesday (Sept. 18).

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Providers and patient advocates are calling on lawmakers to back a bill limiting prior authorization in Medicare Advantage, but the insurance lobby is pressing policymakers not to impose any statutory restrictions on the process.

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Mental health and substance use treatment advocates are calling on Congress to reauthorize funding for mental health clinics, remove barriers to medication-assisted treatment and allow mental health counselors to bill Medicare.

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The Senate Appropriations agriculture subcommittee passed a fiscal 2020 funding bill Tuesday (Sept. 17) that would give FDA an $80 million increase over fiscal 2019 levels, with substantial investments in the agency’s medical countermeasures initiatives, pathogen reduction efforts, compounding oversight, food safety and outbreak prevention, cannabidiol activities and infrastructure maintenance.

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FDA, the National Organization for Rare Disorders and the Critical Path Institute (CBI) launched a data analytics platform that the parties hope will accelerate the development of new cures for rare diseases.

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Former FDA chief Scott Gottlieb has joined the board of directors of Aetion, a health care technology company that delivers real-world evidence for life sciences companies, payers and regulatory agencies, the company announced Tuesday (Sept. 17).

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September 16, 2019

The Certified Community Behavioral Health Clinic demonstration program lost its funding Friday (Sept. 13) for the second time this year after a short-term extension lapsed, threatening access to medication-assisted treatment and the jobs of those who work at these clinics, according to patient advocates.

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State efforts to manage the costs of care for high-expenditure Medicaid beneficiaries have had mixed results, and the most significant barriers to better care management are difficulties dealing with social determinants of health, shortages of providers in rural areas and an inability to contact some beneficiaries, the Government Accountability Office says in a new report.

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Oral arguments in the Trump administration's appeal of a lower court ruling that tossed out much of the Department of Labor’s final association health plan rule will take place Nov. 14 at the U.S. Court of Appeals for the District of Columbia.

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House Energy & Commerce Chairman Frank Pallone (D-NJ) and ranking Republican Greg Walden (OR) launched an investigation into private equity firms’ role in surprise medical billing, starting with three firms that own physician staffing companies and emergency transport companies.

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A major increase in FDA’s budget sought by the House may be slipping out of the agency’s reach due the strong likelihood the government will start fiscal 2020 under a continuing resolution, new hurdles to Senate passage of individual spending bills, and pressure on the House to ratchet back its non-defense spending targets to the meet Bipartisan Budget Act of 2019 budget ceiling.

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Former FDA chief Scott Gottlieb has joined the advisory board of FasterCures, a center of the nonprofit, non-partisan think tank Milken Institute.

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The medical countermeasure research wing of HHS chose five new groups to be part of a nationwide network meant to help boost the development of new products that could help detect illnesses, reduce the damage caused by sepsis and generally protect against public health threats, HHS announced on Monday (Sept. 16).

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September 13, 2019

The California legislature on Thursday (Sept. 12) passed the first state bill discouraging settlements between drug makers that delay generic competition.

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CMS on Friday (Sept. 13) warned states that it will use “deferrals, disallowances or compliance actions” to enforce a new regulatory policy that prevents states from automatically deducting union dues from Medicaid payments made to independent home health workers.

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Plans say prior authorization for medication-assisted treatment (MAT) for individuals with substance use disorders helps the treatment be used safely and effectively, but providers are worried that prior authorization is a barrier to treatment in the middle of an opioid crisis.

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A group of high-profile economists, the association representing state insurance commissioners, the U.S. Chamber of Commerce, key issuer lobbies and other stakeholders have submitted amicus briefs to the Supreme Court supporting health insurance companies who demand the government pay them the total $12 billion or so owed under the Affordable Care Act’s risk corridor program.

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The Department of Transportation formed a task force to look into air ambulance billing, something Congress has been calling on the agency to do since passage of the 2018 Federal Aviation Association Act and made even more urgent by Capitol Hill’s recent focus on ending surprise billing.

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