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Medicaid

November 05, 2014 | Daily News

With the GOP's strong showing in governors' races Tuesday (Nov. 4), including fighting off challenges in what were billed to be six close races in non-Medicaid expansion states, a health care analyst says there won't be any changes to the map of states that have expanded the Medicaid program and those states that have resisted expansion.

November 04, 2014 | Daily News

HHS Secretary Sylvia Burwell urged current governors reluctant to expand Medicaid and newcomers following Tuesday's vote to meet with her to discuss flexible options for expanding the program their own way.

October 30, 2014 | Daily News

The outcome of six close gubernatorial races on Tuesday (Nov. 4) -- in Alaska, Florida, Georgia, Kansas, Maine and Wisconsin, which currently have Republican governors -- could determine whether those states look to expand Medicaid under the Affordable Care Act in 2015.

October 30, 2014 | Daily News

CMS is looking to launch a pilot to provide integrated care similar to the Program of All-Inclusive Care for the Elderly to a younger population, according to one CMS official.

October 29, 2014 | Daily News

CMS next year will likely propose the first revisions to the Medicaid managed care regulations in 12 years, a CMS official said Tuesday (Oct. 28) at a Medicaid Health Plans of America conference.

October 29, 2014 | Daily News

CMS next year will likely propose the first revisions to the Medicaid managed care regulations in 12 years, a CMS official said Tuesday (Oct. 28) at a Medicaid Health Plans of America conference.

October 29, 2014 | Daily News

The HHS Office of Inspector General is expected to publish within the next month a report on Medicaid managed care plans that likely will highlight inaccurate provider directors, CMS Director of the Division of Managed Care Plans James Golden said.

October 28, 2014 | Daily News

Seven hospital trade groups are pressing Genentech to reverse its decision to require three commonly used cancer drugs be sold only through specialty distributors, and not through wholesalers.

October 28, 2014 | Daily News

Medicaid directors want the federal government to either control the price of specialty drugs such as Sovaldi or help states pay for them.

October 23, 2014 | Daily News

A group of nearly 1,200 stakeholders, including hospitals, physicians and families advocates, are urging congressional leaders to take up legislation during the lame duck session that would extend the Children's Health Insurance Program, which is slated to lose funding after Sept. 30, 2015, for an additional four years.

October 22, 2014 | Daily News

Participants at PCORI's recent meeting on hepatitis C treatments struggled to avoid talking about cost because they said they wouldn't be holding a meeting on the treatments were they not so expensive. The ACA-created Patient-Centered Outcomes Research Institute by law is not allowed to fund research on economic outcomes, but the institute put out an updated guidance last month saying it would consider research on how patients' out-of-pocket costs affect access to care.

October 21, 2014 | Daily News

The Health Resources and Services Administration has told more than 50 drug manufacturers to refund 340B hospitals for certain orphan drugs charged at non-discounted prices, complaining the companies did not follow the agency's controversial orphan drug policy that has been the subject of two drug industry court challenges.

HRSA told Inside Health Policy a letter was sent on Oct. 7 giving the manufacturers 30 days to “notify HRSA of plans to repay affected covered entities and to institute the offer of the discounted price in the future.”

October 20, 2014 | Daily News

Congress could allow for binding arbitration to help plans negotiate lower prices for unique specialty drugs, Harvard professors wrote in a January 2008 Health Affairs article that is getting new attention in light of the $94,500 price of a 12-week course of the newly approved hepatitis C drug Harvoni. The Center for a Responsible Federal Budget drew attention to the old proposal to help advance the debate over how, or whether, steps should be taken to control the price of specialty drugs.

October 17, 2014 | Daily News

UnitedHealth Group, which entered only a handful of health insurance exchanges in year one, is on track to participate in about about two dozen states in 2015, United executives said in an earnings call with investors. United expects to be profitable in the exchange market over the long term, but officials say it will fall short of its goal of 3 to 5 percent margins in that sector next year. In the Medicaid arena, United is on course to grow by just under 1 million new members, which a company official touted as a record level of organic growth.”

October 16, 2014 | Daily News

The ACA's Patient-Centered Outcomes Research Institute will meet Friday to gather public input on whether comparative effectiveness research could inform hepatitis C treatment. Some of the research questions that PCORI will likely be asked to fund target reimbursement restrictions that states have put in place on Gilead Science's hepatitis C drugs, and a PCORI official says the institute does not intend to compare breakthrough hepatitis C drugs to older, less effective treatments.

October 10, 2014 | Daily News

Gilead Science's revelation Friday (Oct. 10) that it will charge $94,500 for a 12-week course of its newly approved hepatitis C drug Harvoni, though less than some market analysts had expected, stoked the national drug pricing debate, with drug price-control advocate promptly urging Congress to stem a brewing crises of what they called “excessive pricing” by drug makers.

October 09, 2014 | Daily News

CMS says that states should reimburse Medicaid managed care plans for the Affordable Care Act's health insurance provider fee, and says that the fee itself should be incorporated into plans' capitation rates, however, as the firm JP Morgan notes, the agency leaves some “wiggle room” on whether states should also factor in other potential effects of the fee, such as its non-deductibility status.

October 09, 2014 | Daily News

HHS officials and advocates for people with disabilities are advising Medicaid managed care organizations (MCOs) to pay close attention to how states implement a new home and community-based services rule issued by CMS earlier this year. One advocate warned insurers last week that states' failure to fully live up to the new HCBS rules could make MCOs the target of lawsuits.

October 03, 2014 | Daily News

Key Republican lawmakers question CMS' ability to oversee a $7 billion contract awarded by the innovation center to drive demonstrations on major delivery reforms across agency programs, raising their concerns in a letter to CMS Thursday (Oct. 2) as the innovation center was seeking stakeholders' input on a wide array of potential innovations.

October 03, 2014 | Daily News

CMS is seeking stakeholders' advice on whether the agency should test Medicaid managed care reforms in the areas of pharmacy and medication management, value-based insurance design, telehealth, hospice care, long term services and supports, network design, behavioral health, and provider incentive arrangements like accountable care organizations in order to potentially reduce costs while improving quality of care.

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