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Inside CMS - 09/20/2018

  • Changes To IMD Exclusion Still Under Consideration For Final Opioid Bill

    Despite being omitted from the Senate's recently approved opioid bill, some rollback of a federal prohibition on using Medicaid funds to pay for substance-abuse treatment in large inpatient facilities may still be included in the final version of opioid legislation slated to be released in coming days, Senate aides say.

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  • AHA Touts New Voluntary 340B Stewardship Principles As Alternative To Legislation

    The American Hospital Association on Tuesday (Sept. 18) touted a new voluntary 340B reporting program as an alternative to legislation to help achieve transparency in the 340B program, but key lawmakers and the pharmaceutical industry disagreed. House Energy & Commerce health subcommittee Chair Michael Burgess (R-TX) and Reps. Larry Bucshon (R-IN) and Buddy Carter (R-GA) told Inside Health Policy the principles are a good first step, but Bucshon and Carter said they don't remove the need for congressional action and Burgess said he believes "we can come to a consensus on sensible reforms to the 340B program."

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  • MACPAC Alarmed By Initial Data On Arkansas Medicaid Work Requirements

    Congressional Medicaid advisers expressed dismay Thursday (Sept. 13) at early numbers out of Arkansas showing low compliance rates with and significant coverage losses as a result of the state's new Medicaid work requirements. Members of the Medicaid and CHIP Payment and Access Commission urged the commission to convey their concerns to CMS, and a few suggested the early numbers are so worrisome that the agency should force the state to put the work requirements on hold.

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  • Verma: CMS Looking Closely At Suggestions To Improve E/M Pay Proposal

    CMS is looking closely at stakeholder suggestions on ways to improve the agency's proposal to simplify evaluation and management codes and consolidate payment, CMS Administrator Seema Verma said on Monday (Sept. 17). The E/M proposal generated overwhelming opposition from providers and lawmakers.

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  • National Uninsured Rate Unchanged During Administration's First Year

    The national uninsured rate held steady at 8.8 percent from 2016 to 2017 despite federal uncertainty surrounding the Affordable Care Act, according to new data from the U.S. Census Bureau. Although the national uninsured rate didn't change, there was some variation in individual states -- the uninsured rate increased in 14 states from 2016 to 2017.

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  • CMS Seeks To Change Providers' Participation And Coverage Conditions

    CMS on Monday (Sept. 17) proposed changes to Conditions of Participation and Conditions of Coverage for a wide range of providers, including hospitals, home health providers and transplant centers, in a bid to simplify and streamline processes, reduce or change the frequency of certain activities, and do away with obsolete, duplicative or unnecessary requirements.

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  • States Seek To Block Collection Of ACA Tax On Medicaid Plans

    Six states engaged in litigation over an Obamacare tax on Medicaid plans filed papers this week asking a Texas federal judge to block the IRS from collecting that tax on Oct. 1. The states argue that federal regulations are illegally forcing the states to cover the cost of the tax by paying higher capitation rates to the managed-care companies that operate the states' Medicaid programs.

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  • MACPAC Favors Grace Period For States Before Covering New Drugs

    Several congressional Medicaid advisers said Thursday (Sept. 13) they're enthusiastic about the idea of giving states a grace period before covering newly approved drugs and lifting the Medicaid rebate cap. However, members of the Medicaid and CHIP Payment and Access Commission (MACPAC) said they are wary of allowing states to use closed formularies or to increase rebates on either expensive drugs or drugs granted fast approvals. Some commissioners said they like the idea of basing drug reimbursement on performance, but they said so-called value-based pay is unproven and seldom-used.

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  • E&C Sends Medicaid, Anti-Fraud Legislation To House Floor

    The House Energy & Commerce Committee passed a number of Medicaid and anti-fraud bills on Thursday (Sept.13), including a one-year extension of the Medicaid Money Follows the Person demonstration and a tweaked version of the ACE Kids Act.

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  • Judge Retains Control Over Second Lawsuit On Work Requirements

    The same federal judge who blocked Kentucky from implementing Medicaid work requirements in July will preside over the recently filed lawsuit challenging Arkansas' similar work-requirement program.

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  • LCD Reform Bill Passes House; Pathologists Seek Changes In Senate

    The Advanced Medical Technology Association praised a Local Coverage Decision transparency bill that passed the House by voice vote Wednesday (Sept. 12), but the College of American Pathologists is urging the Senate to reinsert a key provision removed by Ways & Means and said the bill's appeals language was weakened prior to the House vote.

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  • Generics, Brands Push Deal That Couples REMS Reforms With Part D Measure

    Sources say brand and generic drug trade groups have agreed in principle on a deal that couples a tweaked version of the generic-backed bill to stop brands from using drug safety requirements to delay competition with brand-backed Part D bills to reduce brands' contribution to beneficiaries' donut hole costs and avert the so-called coverage gap "cliff." Patients for Affordable Drugs describes the changes in brands' donut hole contribution as a "fast-moving deal" that would benefit brands at the expense of patients, but a brand lobbyist said the deal does not currently have much momentum.

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  • Verma: Too Early To Judge Arkansas' Medicaid Work Requirements

    CMS Administrator Seema Verma said Monday (Sept. 17) that it is too early to draw conclusions about Arkansas' newly enacted Medicaid work requirements, after more than 4,000 beneficiaries lost coverage for failing to show they met the requirements in the program's first three months.

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  • Senate Passes Bill To Ban Pharmacy Gag Orders

    The Senate voted 98-to-2 for legislation to stop all health plans and pharmacy benefit managers in the commercial market from using gag orders to prevent pharmacists from telling customers, unless asked, when it is cheaper to buy drugs without insurance. The bill also requires that drug companies file biosimilars patent settlements with the Federal Trade Commission in order to give the FTC more visibility into so-called pay-for-delay agreements between makers of brand biologics and biosimilars.

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  • CMS To Let People Apply For Individual Mandate Exemptions On Tax Forms

    CMS announced that for 2018, the final year the individual mandate is in effect, the agency will make it easier for individuals to apply for hardship exemptions absolving them from paying the Affordable Care Act's individual mandate penalty. The guidance allows individuals to claim hardship exemptions on their 2018 federal income tax returns, as opposed to having to obtain an exemption certificate number (ECN) from the exchange to be relieved of the penalty for not having health insurance.

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  • In New Lawsuit, Maryland Asks Court To Declare ACA Constitutional

    Maryland's attorney general on Thursday (Sept. 13) filed suit against the federal government for its ongoing attacks against the Affordable Care Act, and asked the court to declare the law constitutional. Maryland's suit comes after the Trump administration refused to fully defend the ACA from a constitutional challenge by 20 GOP-led states -- a suit on which a federal judge in Texas recently heard oral arguments.

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  • Justice Approves Cigna/Express Scripts Merger Without Conditions

    The Justice Department's antitrust division approved, without conditions, Cigna's proposed $67 billion purchase of Express Scripts, despite concerns that allowing the insurer and pharmacy benefit manager to merge could lead to higher drug prices.

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  • Court Dismisses Non-Discrimination Suit Over Hearing Aid Coverage

    A federal judge on Friday (Sept. 14) dismissed a suit against Kaiser Permanente that charged the issuer's decision to cover cochlear implants but not hearing aids violated the Affordable Care Act's 1557 non-discrimination provisions, which bars plans from discriminating on the base of race, disability, color, national origin, sex, or transgender status. Clinton-appointed Judge Robert Lasnik, senior judge with the U.S. District Court for the Western District of Washington in Seattle, scrapped the case after agreeing with the defendants that the plaintiff did not meet the threshold for a disability claim.

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  • More Than 4,000 Arkansans Lose Medicaid Due To Work Requirements

    Arkansas has kicked 4,353 people off Medicaid for not complying with the state's new work requirements -- nearly four times more than the number of beneficiaries who successfully reported to the state that they satisfied the new rules. Gov. Asa Hutchinson (R) said he wishes fewer beneficiaries were losing coverage, but he touted the program as "compassionate" and said the reduction in the Medicaid rolls would save the state $30 million.

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  • Rules Committee Clears $51.6B ACA Employer Relief Bill

    The House Rules Committee on Wednesday (Sept. 12) cleared a $51.6 billion legislative package to provide employers relief from several Affordable Care Act taxes and other mandates, but a final floor vote, which was slated for Friday, will now occur later this month due to the congressional work week being cut short by the East Coast hurricane. The House is on recess this week.

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  • White House Places HHS At Helm Of National Biodefense Strategy

    HHS Secretary Alex Azar will chair a new cabinet-level interagency biodefense steering committee launched by the White House as part of a new National Biodefense Strategy unveiled Tuesday (Sept. 18). The strategy, in addition to considering man-made and accidental biological threats, will take into account for the first time naturally occurring threats, Azar emphasized.

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  • Senate Passes Bill To Ban Pharmacy Gag Orders

    The Senate voted 98-to-2 for legislation to stop all health plans and pharmacy benefit managers in the commercial market from using gag orders to prevent pharmacists from telling customers, unless asked, when it is cheaper to buy drugs without insurance. The bill also requires that drug companies file biosimilars patent settlements with the Federal Trade Commission in order to give the FTC more visibility into so-called pay-for-delay agreements between makers of brand biologics and biosimilars.

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  • Drastically Reduced Navigator Grants Go To Many Returning Organizations

    Advocates remain upset the agency has slashed funding for the navigator program, but are relieved to see CMS allocated money Wednesday (Sept. 12) to community-based organizations, many of which had previously been awarded grants, rather than a centralized entity with no local presence.

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  • Final CT Rates Average 2.7 Percent In Individual Market, Less Than Proposed

    Connecticut's Department of Insurance on Thursday (Sept. 13) announced that consumers in the individual and small business exchanges will see average increases significantly lower than what the issuers initially requested. Final rates in the individual exchange market will go up an average 2.72 percent, down from the 12 percent average issuers proposed, and small business plans will see increases of 3.14 percent, down from the proposed rate of just over 10 percent, the department said.

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  • Measure To Make Drug Makers Disclose Prices In Ads Is Dropped

    Lawmakers stripped a measure to require that drug companies list prices in drug advertisements from appropriations legislation because it was too controversial with House GOP lawmakers, Senate appropriations conferees said Thursday (Sept. 13).

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