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Medicaid

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.

July 16, 2014 | Daily News

The drug industry won a lawsuit challenging the administration’s execution of 340B drug-discount program, but now the Health Resources and Services Administration is saying industry will have to sue again if it wishes to challenge the same policy because HRSA is using a different type of regulation to implement its interpretation of how the health law's 340B provision applies to orphan drugs.

July 16, 2014 | Daily News

HHS has created a portal on the CMS website to help states coordinate Medicaid innovation efforts with each other and the federal government, responding to governors' long-standing calls for CMS to make it easier for state Medicaid programs to learn from successful delivery system and payment reforms around the country.

July 16, 2014 | Daily News

A new network of state-regulated compounding pharmacies aims to help compounders that meet a higher bar -- based on accreditation and quality standards -- negotiate with payors and pharmacy benefit managers, which in recent weeks have begun limiting coverage of certain compounded drugs due to the rising costs of the products. The latest move adds to other other recent efforts by compounders to curb the coverage restrictions, which industry, payors and PBMs attribute to billing changes and increased utilization.

July 15, 2014 | Daily News

California expects that six weeks from now it could still have roughly 350,000 pending applications for Medicaid coverage to work through -- a little more than half the number pending at the end of June -- according to its response to CMS' demand that six states submit updated plans by Monday (July 14) for getting through a backlog of Medicaid eligibility determinations and enrollments.

July 15, 2014 | Daily News

The National Coalition on Health Care is spearheading an effort to get drug makers to disclose how much they spend inventing drugs and their rationale for drug prices. The broad-based stakeholder group is trying to set up a meeting with the drug industry and other stakeholders to figure out how the transparency measures would work, but a Pharmaceutical Research and Manufacturers of America official indicated that the drug trade group is not interest in negotiating.

July 14, 2014 | Daily News

The Health Resources and Services Administration revealed Monday (July 14) that it will propose a new interpretive rule on the 340B orphan drug exclusion in the next few days that allows for discounts for non-orphan uses of orphan drugs after a court agreed with the drug industry that HRSA overstepped its authority with a previous orphan drug rule.

Rep. Henry Waxman (D-CA), who was the primary author of the 340B legislation in 1993, said Monday that HRSA's decision is the right one, because the agency's interpretation meets the legislative intent of the law.

July 14, 2014 | Daily News

In the first overhaul of performance criteria that determine accountable care organizations' bonuses, CMS proposed on July 3 to add 12 measures and retire eight of the existing 33 measures.

July 09, 2014 | Daily News

CMS unveiled the second round of health care innovation awards Wednesday (July 9), increasing funding for both rounds of grants to up to $360 million for awards focusing on four areas that include reducing costs for hospital outpatients and testing improvements for certain providers.

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