Medicaid

CMS Administrator Seema Verma said the agency is working to get a final rule updating the Program of All-Inclusive Care for the Elderly published as part of CMS’ commitment to improving care for those dually eligible for Medicare and Medicaid.

CMS Administrator Seema Verma on Wednesday (April 24) invited states that aren’t currently participating in the duals demonstration to talk with the agency about starting their own version, whether through the capitated financial alignment model, the managed fee-for-service model or some other state-specific model worked out with the agency.

Ohio Attorney General Dave Yost (R) on Monday (April 22) called for the Ohio legislature to enact four policies targeting spread pricing practices by pharmacy benefit managers that would route all state drug purchases through a single PBM contract, give the state auditor unrestricted authority to review all PBM drug contracts, make PBMs fiduciaries and ban nondisclosure agreements regarding drug pricing with the state.

A federal appeals court has agreed to expedite its consideration of the two cases challenging the legality of Medicaid work requirements after CMS asked that the cases be accelerated.

The Congressional Budget Office estimates that 1.4 million more people went uninsured in 2018 compared to 2016 and most of the drop came from unsubsidized individuals in the individual market.

CMS reversed course and, along with the Office of the National Coordinator for Health IT, will give stakeholders an additional 30 days to comment on proposed interoperability rules the agencies released in February, pushing the comment deadline back to June 3.

Kentucky’s Cabinet of Health and Family Services touted an independent evaluator’s plan to use a randomized control population to evaluate the state’s controversial work requirements program, but the evaluation’s approval is now on hold as CMS appeals a pair of judicial decisions that blocked Medicaid work requirements in Arkansas and Kentucky.

A provision in the Trump administration’s point-of-sale rebate proposal questioning whether formulary placement-related rebates are protected by the anti-kickback statute generated strong reactions from the generic drug and pharmacy benefit manager lobbies, which are at odds on the issue.

Federal Medicaid advisers expressed general support for CMS’ goal to encourage better sharing of electronic health records through its recent proposed rule on interoperability, but they declined Friday (April 12) to weigh in with any formal comments on the proposed rule, even as a few commissioners worried that the rule’s timeline for implementing new data-access requirements is too aggressive.