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Medicaid

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.

August 19, 2014 | Daily News

Enroll America doesn't plan to expand the number of states where it placed field staff to get people insured but it will be launching some new tools and doing more active recruitment of assisters going into the forthcoming open enrollment period, the non-profit's president tells Inside Health Policy. Enroll America President Anne Filipic says she doesn't think a dramatically different strategy is needed for the second open enrollment period to get people covered.

August 19, 2014 | Daily News

Just as the country is on the verge of a significant increase in drug spending, brand-drug makers are lobbying for a trade deal that could severely constrain the ability of Medicare to curb drug prices, consumer groups warn.

August 15, 2014 | Daily News

Consumer advocate and broker sources are praising two new special enrollment periods that will let people enroll in subsidized coverage on healthcare.gov if they were denied due to a system error or because they lived in a non-Medicaid expansion state and were below the poverty line but then saw an increase in income.

August 04, 2014 | Daily News

Medicare will pay acute-care hospitals 1.4 percent more next year and long-term care hospitals will receive a 1.1 percent pay bump, according to the final Inpatient Prospective Payment System rule issued Monday (Aug. 4), but CMS expects a nearly $1 billion reduction in Disproportionate Share Hospital pay and programs that penalize hospitals for poor performance will offset their pay increase considerably.

August 04, 2014 | Daily News

Patients infected with hepatitis C are preparing to sue in short order states that restrict Medicaid coverage of Sovaldi, and they're using as a model a lawsuit that cystic fibrosis patients recently filed in Arkansas, where Medicaid uses a prior authorization policy to curb use of the cystic fibrosis drug Kalydeco, according to Donna Cryer, of the Global Liver Institute. National Association of Medicaid Directors Executive Director Matt Salo said he isn't surprised that liver patients plan to sue but he thinks patient groups are using the wrong tactic.

July 30, 2014 | Daily News

In the flood of bills leading up to August recess, Sens. Patty Murray (D-WA) and Sherrod Brown (D-OH) on Wednesday (July 30) introduced legislation to extend by two years an ACA policy that temporarily bumped up Medicaid payments for primary care physician services to match Medicare rates. The bill also would expand the higher pay rates to certain women's services.

July 29, 2014 | Daily News

A bipartisan, bicameral group of lawmakers Tuesday (July 29) asked governors for advice on how to extend or revise the Children's Health Insurance Program, which will lose funding after Sept. 30, 2015. The lawmakers' letter came the same day the National Coalition on Health Care (NCHC) urged Congress to fund CHIP this year, and as children's advocate First Focus released a report showing that CHIP provides less expensive, more comprehensive coverage than exchange policies.

July 29, 2014 | Daily News

The Government Accountability Office recommended Tuesday (July 29) that CMS increase its oversight and transparency of funding sources that states use to pay their share of Medicaid because states often bump up federal-match Medicaid payments by taxing providers and making local governments chip in for Medicaid.

July 25, 2014 | Daily News

Republican governors sent Senate leaders Medicaid proposals that track closely with ideas state Medicaid directors are urging CMS to embrace: streamline and move away from waiver requirements; treat states as full partners in the rulemaking process; and make pricing transparent.

July 24, 2014 | Daily News

The National Association of Medicaid Directors sent CMS initial recommendations for revamping Medicaid managed care regulations after hearing informally that the agency hopes to update rules that have been in place since the 1990s, with a key proposal that CMS move away from requiring waivers for any changes states make to Medicaid managed care programs. The Medicaid directors also made a strong pitch to play an active role as CMS crafts regulatory updates.

July 24, 2014 | Daily News

Gilead's revelation Wednesday (July 23) that it sold $3.48 billion of its breakthrough hepatitis C drug Sovaldi in the second quarter of this year alone -- beating even Wall Street expectations -- fueled an already heated national drug pricing debate, spurring health plans, a broad-based stakeholder coalition and lawmakers to again demand the company voluntarily lower the $84,000-per-course cost of the drug. At the same time, a key House Democrat conceded Congress is unlikely to act.

July 23, 2014 | Daily News

HHS announced the hiring of a new senior counselor on Wednesday (July 23) who will report directly to HHS Secretary Sylvia Mathews Burwell and “work very closely with HHS and the CMS leadership to help ensure the success of the second open enrollment period.” Leslie Dach -- a former Walmart executive who was with the company when Burwell led its foundation starting in 2012 -- will fill the new role, the department said.

July 21, 2014 | Daily News

The Health Resources and Services Administration on Monday (July 21) issued an interpretive rule, expected by stakeholders, restating its view that orphan drugs used for non-orphan purposes are subject to 340B drug discounts -- a move the drug industry views as a “government power play” to get around a court ruling in PhRMA's favor and has asked the court to step in.

July 16, 2014 | Daily News

The brand drug industry is pivoting from justifying drug prices based on research and development costs to justifying them based on the product's value to the health care system, a move that comes as key lawmakers, health plans and large employers -- upset by rising drug prices -- urge drug makers to disclose their research spending and their rationale for prices.

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