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October 01, 2014 | Daily News

Medicaid directors sent CMS a third set of proposals for updating Medicaid managed care regulations that ask the agency to give states leeway in setting policies on network adequacy, enrollment, managed long-term services and supports, and communications with beneficiaries. States are best suited to understand the nuances and specific needs of their distinct Medicaid populations, the directors say, warning that national, one-size-fits-all regulations from the agency could undermine the program.

October 01, 2014 | Daily News

A bipartisan, bicameral group of lawmakers from the House Energy and Commerce Committee and the Senate Finance Committee are asking trade groups that represent Medicaid managed care plan providers to provide information on how plans provide cost savings and quality health care as a majority of Medicaid beneficiaries find themselves in some type of managed care program. Medicaid Health Plans of America President and CEO Jeff Myers said the timing of the request is perfect because his group plans to publish a compendium of best practices for Medicaid managed care plans later this month.

September 30, 2014 | Daily News

CMS is considering letting accountable care organizations combine with drug plans and Medicaid and accept global payments, CMS innovation center head Patrick Conway said Tuesday (Sept. 30). The agency plans to soon request input from the public on plan designs for CMS to test, and that “request for information” will provide an opportunity for plans to suggest changes to ACOs.

September 26, 2014 | Daily News

U.S. patient advocate groups and labor unions are ratcheting up their effort to convince the Obama administration to back away from provisions it has proposed in the Trans-Pacific Partnership (TPP) negotiations that the groups fear could help multinational drug companies drive up pharmaceutical prices under public health programs in the United States.

September 26, 2014 | Daily News

U.S. Trade Representative employees tried to reassure consumer advocates and unions during a meeting this summer that a draft Trans-Pacific Partnership deal would not lead to companies blocking government efforts to control the cost of specialty drugs in Medicaid, Medicare Part B and other government programs.

September 25, 2014 | Daily News

Governors suggest in a new report that states consider easing restrictions on physician assistants to help deal with swelling Medicaid rolls. The National Governors Association says states should consider including PAs in the definition of "provider," loosening so-called scope-of-practice laws to let physicians delegate more tasks to PAs, opening clinical training sites and encouraging PAs to work in primary care.

September 25, 2014 | Daily News

Researchers at Harvard and Brown universities are analyzing state Medicaid programs' coverage restrictions for the expensive hepatitis C drug Sovaldi, and the findings could lay the groundwork for beneficiaries to sue states, although a Harvard law instructor said legal action is a last resort. Patient advocates are especially angry at states that refuse to give the hepatitis C drug to alcoholics and drug addicts, arguing the policy is discriminatory and has no medical basis.

September 24, 2014 | Daily News

The American College of Physicians is pushing hard for legislation that would extend the Medicaid pay bump for primary care physicians for at least two years saying it is necessary to ensure the state and federal health care program for low-income individuals and children has enough providers to meet beneficiaries needs. A nonprofit health care policy resource center, however, says that the program has not been in place long enough to assess its effectiveness, and policy fixes are needed if the pay bump is extended.

September 22, 2014 | Daily News

Congressional Medicaid and CHIP advisers questioned the former Arkansas Medicaid director and others about whether more state Medicaid programs should consider a premium assistance model, and one commissioner said that while they were excited about the approach there is concern that a recent Government Accountability Office report slamming the costs of Arkansas' program could dampen enthusiasm for the model.

September 18, 2014 | Daily News

Medicaid-beneficiary advocates filed a lawsuit Wednesday (Sept. 17) in California accusing the state of making hundreds of thousands of Medicaid applicants wait months without coverage that many desperately need and, by law, deserve. A day later, key House and Senate Republicans blamed CMS for the application logjams in many states.

September 18, 2014 | Daily News

As more Medicaid beneficiaries are enrolled in managed care plans, the National Association of Medicaid Directors is urging CMS to focus on four overarching program-integrity areas: provider enrollment; data reporting; compliance; and benefits' coordination. Streamlining processes and offering guidance to states in these areas requires the agency to work closely with state Medicaid programs and highlight some of the most innovative and efficient state practices, NAMD says in a letter to CMS.

September 17, 2014 | Daily News

Sen. Jay Rockefeller (D-WV), the driving force behind the bipartisan Children's Health Insurance Program, is extolling Congress to extend the program's funding through 2019 during the lame duck session following the November elections, warning that failing to do so would cause millions of children to lose their coverage and wreak havoc on states' already strained budgets.

September 12, 2014 | Daily News

States and some lawmakers are pushing for CMS to extend the Multi-Payer Advanced Primary Care Practice demonstration beyond 2014, though one state policy expert says it may be time to move beyond multi-payer demonstrations that focus exclusively on primary care. A CMS official last month told Inside Health Policy the agency was considering demo extension requests from several states, and a key stakeholder says final word on the demo's future likely rests with the White House.

September 12, 2014 | Daily News

Two reports from the Urban Institute and Georgetown University's Center for Children and Families found that the estimated uninsured rate for parents fell by 14.4 percent nationwide but the estimated rate of uninsured children -- which was already low -- has seen no statistically significant movement due to the ACA's coverage expansions.

September 11, 2014 | Daily News

As CMS plans its first major update of Medicaid managed care regulations since 2002, Medicaid Health Plans of America is asking that states and Medicaid managed care organizations (MCO) have the ability to adjust rates when new, higher-priced medications and procedures come into the market place, such as the hepatitis C drug Sovaldi, which costs an average of $84,000 for a treatment regimen.

September 05, 2014 | Daily News

The Center for American Progress is proposing a new multi-payer “Accountable Care States” model under which CMS would offer broad payment reform flexibility to states limiting per-capita spending and in turn share with states the resulting health care savings, which the group estimates could reach $1.7 trillion over 10 years.

Were the Accountable Care State model to take off, CAP says, CMS should create a new Office of Accountable Care States to review and approve one application covering Medicaid waivers, Medicare waivers and changes to state-run health insurance exchanges.

September 04, 2014 | Daily News

Reacting to CMS actuaries' finding that health care spending is creeping back up after an historic slowdown of five consecutive years of spending growth below 4 percent, a well-known health care economist said cuts to physician pay or program benefits likely will be necessary to sustain Medicare unless the country is willing to raise taxes.

August 25, 2014 | Daily News

An insurer participating in Iowa's exchange and enrolling Medicaid beneficiaries into its private plans says the Medicaid premium assistance population is higher cost than the company's baseline exchange business, however state officials could not say if this will result in higher exchange premiums for 2015. Iowa, like Arkansas which pioneered it, has expanded Medicaid using a model in which beneficiaries enroll in exchange plans and their premiums are subsidized using the ACA's higher Medicaid matching funds.

August 21, 2014 | Daily News

Contrary to popular belief, most of the emergency room visits by Medicaid beneficiaries are for urgent symptoms that require quick medical attention, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). According to studies, MACPAC says non-urgent visits to the emergency room make up only 10 percent of Medicaid-covered emergency department visits in its July “MACfacts” report.

August 20, 2014 | Daily News

The Bipartisan Policy Center turned pessimistic about the prospect of Congress comprehensively changing the health care system and is instead focusing on smaller reforms that Congress can make when it next deals with the Medicare physician pay formula and on changes CMS can make administratively. The center released a white paper Tuesday (Aug. 19) that scales back expectations for overhauling the health care system.

The white paper is the first in a series on changes to the fee-for-service Medicare and alternative pay demonstrations.