Proposed CMS Rule Would Allow Some States To Skirt Medicaid Network Adequacy Requirement.
Modern Healthcare (3/22, Dickson, Subscription Publication) reports “CMS is letting some states off the hook when it comes to complying with an Obama-era rule that’s meant to ensure Medicaid beneficiaries have adequate access to care.” Three years ago, the agency “finalized a rule requiring states to assess how easy it is for fee-for-service Medicaid beneficiaries to receive primary care; pre- and post-natal obstetric services; and specialty and behavioral health care, among other services.” But on Thursday, it “issued a proposed rule that would exempt states if the majority of their Medicaid population received services through managed-care plans.” CMS Administrator Seema Verma said, “These new policies do not mean that we aren’t interested in beneficiary access but are intended to relieve unnecessary regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.”
Legislation and Policy
Cornyn Says Senate Will Vote On ACA Stabilization Legislation.
The Hill (3/22, Sullivan) reports that on Thursday, Senate Majority Whip John Cornyn (R-TX) said “‘there will be a vote’ on a GOP bill to lower ObamaCare premiums.” But he did not explain “whether the vote would come as an amendment to the must-pass government funding bill or as a standalone measure.”
Trump Administration Changes Payment Policy On Biologics.
The Wall Street Journal (3/22, Walker, Subscription Publication) reports the Trump Administration changed a Medicare payment policy that rewarded physicians who used the lowest-price biosimilar versions of biologics. Supporters say the policy change encourages investment in biologics, while critics, including MedPAC and AHIP, say the change will increase prices.
Idaho House Votes Against Motion To Consider Bill That Would Provide Family Planning Services For Low-Income Women.
The Idaho Press Tribune (3/22, Pfannenstiel) reports that on Thursday, Idaho’s House voted against a motion “to consider a bill funding family planning services for low-income women, marking another stalemate in legislative action to help the state’s health insurance gap population.” The article says the measure, HB 563, had “been on the House Reading Calendar for weeks and its consideration was delayed until April 1 – after the legislature hopes to adjourn. A motion to move the bill to the top of the Third Reading Calendar failed on a 14-55 vote.”
The AP (3/22, Kruesi) reports that the bill, known as Plan First Idaho, would have provided assistance to some 15,000 women. But “Republicans members maintained their resistance to addressing the population who currently earn too much to qualify for Medicaid, but too little to qualify for insurance subsidies.”
Bill To Study Medicaid Public Option In Connecticut Narrowly Clears Committee.
The CT News Junkie (3/22, Stuart) reports that a bill to study a Medicaid public option for health insurance in Connecticut “squeaked through the Human Services Committee Thursday on a party line vote,” ten votes to nine. Republicans objected to the “subject matter of the bill” and questioned the “makeup of the group which would be overseeing the study because seven of the nine members would be Democrats.”
Public Health and Private Healthcare Systems
ACOs Exit CMS’ Next Generation Program Because Of Changes.
Modern Healthcare (3/22, Castellucci, Subscription Publication) reports that seven accountable care organizations have withdrawn from CMS’ Next Generation ACO Model program, leaving 51 ACOs in the group. Four of the seven “indicated that they decided to withdraw because changes made to the model’s design, including the chosen risk adjustment, would directly hurt their ability to make money in the program.” The article explains, “The biggest change to the model’s design was the CMS’ decision to lower the average risk score for 2017 by 4.82%, effectively making it more difficult to save money and earn a bonus or avoid a penalty.” One provider, Sharp HealthCare in San Diego, signaled that it was considering legal action because it faces financial losses due to the changes.
Bipartisan Lawmakers Ask CMS’ Verma About Drug Misclassifications Under Medicaid.
STAT Plus (3/22, Swetlitz, Subscription Publication) reports a group of ten bipartisan lawmakers sent a letter to CMS Administrator Seema Verma saying that they were “‘deeply concerned’ about her agency’s oversight of the way Medicaid pays for drugs.” The letter focuses on the Medicaid Drug Rebate Program and how drugs are classified – or misclassified. A 2017 report from the Office of the Inspector General of the Department of Health and Human Services found that 885 drugs may have been misclassified. The letter asked whether the agency “needs more legal powers to hold drug companies accountable.”
Physicians Request Overhaul Of Some Medicare Billing Codes.
Modern Healthcare (3/22, Dickson, Subscription Publication) reports physicians told the CMS Wednesday on a conference call that “lowering documentation standards for a commonly used set of billing codes would lead to better quality of care.” The physicians noted that the last update to the “evaluation and management visit codes” occurred more than 20 years ago, and the claims “were developed with a paper-based system in mind.” Marge Watchorn, deputy director of CMS’ Division of Practitioner Services, responded, “The agency has heard repeatedly over the years that these documentation guidelines are potentially outdated and need to be revised.”
Tennessee Senate Delays Vote On Work Requirements For TennCare.
The Tennessean (3/22, Ebert) reports the Tennessee state Senate delayed voting on legislation that would impose work requirements on recipients of TennCare, the state’s Medicaid program. State Sen. Kerry Roberts (R-Springfield), one of the co-sponsors of the bill, “asked that the measure to be sent back to the Senate calendar committee – a procedural move that delays a floor vote on the bill until a future date.” According to the article, “Roberts declined to explain why he made the move,” although Lt. Gov. Randy McNally (R-Oak Ridge) said while speaking to reporters, “I just wanted to check with the (Trump) administration and make sure that implementation of that bill is lined up and goes smoothly.”
Also reporting is the Chattanooga (TN) Times Free Press (3/23, Sher).
Mississippi Saves $4.6 Million In First Year Of Medicaid Pharmacy Program.
The Jackson (MS) Clarion Ledger (3/22, Wolfe) reports Mississippi officials say they have saved $4.6 million this year under the state’s Medicaid pharmacy program called the Complex Pharmacy Program. The goal of the program is to give “more guidance to patients with specific, costly health issues, so that medications are taken as intended and in the most cost-effective manner.” Dorothy Young, Medicaid’s deputy director of health services, “said the program’s purpose is ‘not to avoid costs, but to make sure we’re supporting the providers caring for our beneficiaries.’”
Louisiana State Lawmakers Debate Whether To Use Tax Filings To Review Eligibility For Medicaid Recipients.
The AP (3/22, Deslatte) reports Louisiana lawmakers sparred Wednesday over a proposal to allow the state’s legislative auditor to review people’s state income tax returns in order to check Medicaid eligibility. Critics argued that the proposal “unfairly targets the poor” and an improper use of private tax information, while supporters – mostly Republican – contended that the proposal was an anti-fraud proposal “aimed at saving taxpayer dollars on a pricey health care program.”
Washington State To Fine Centene $100,000 For Failing To Address Physician Shortage.
Bloomberg News (3/22, Tracer) reports Centene Corp. has yet to address “problems in Washington that led the state to briefly bar the health insurer from selling Obamacare plans, the insurance regulator there said Thursday.” Consequently, the state “will fine Centene’s Coordinated Care unit $100,000 for not complying with a December agreement to boost coverage of physicians such as anesthesiologists, Steve Valandra, deputy commissioner for public affairs at the state’s Office of the Insurance Commissioner, said.” The article says this is “a setback” for Centene, and mentions that CEO Michael Neidorff “has used many of the strategies developed in its Medicaid business as Centene expands its Obamacare offerings, including limiting where its members can get care to hospitals and signing up doctors willing to accept lower reimbursement rates.”
Also in the News
CMS Innovation Center Experiencing Exodus Of Top Officials.
Politico (3/22, Pittman) reports that there has been a “recent exodus of top officials at the CMS Innovation Center,” noting that under the Trump Administration, “the office has done little over the past year to put into action new ideas for improving care and tackling health care costs.” Politico adds, “But as Alex Azar settles into his new job, experts closely watching the innovation center say the new HHS secretary could have carte blanche to leverage the office’s powers to experiment with long-sought conservative reforms, ranging from physician payment to Medicare vouchers.” HHS spokeswoman Caitlin Oakley said that Azar would like to “harness the power of Medicare to drive innovation” and believes CMMI is important to that objective. CMS Administrator Seema Verma added that CMMI is “an important tool for improving America’s health care system” and moving “towards a system that pays for quality and value.”
Insurer Mergers With PBMs Raise Questions On The Effects For Consumers.
STAT Plus (3/22, Ross, Subscription Publication) reports on the industry of pharmacy benefit managers (PBMs), explaining that the three largest PBMs now “control about 70 percent of the market in the U.S.” and “if approved by authorities, all of them will soon be combined with insurance companies.” The article says that the mergers will not “mean the influence of these companies will disappear or become more diffuse,” rather, “it will be channeled through much bigger businesses whose potential impacts on competition and pricing are already generating fierce debate.” On the one hand, “PBMs and insurers say the combined companies will create efficiencies and lower prices, while their critics argue that they will accomplish the exact opposite.”
Healthcare Companies Turning To Pharmaceutical Executives As Industry Changes.
The Wall Street Journal (3/22, Minaya, Subscription Publication) reports healthcare companies are hiring executives from pharmaceutical companies as the two industries increasingly converge. The Journal reports that healthcare companies are seeking pharmaceutical executives with experience navigating an industry undergoing consolidation, The article highlights several examples such as UnitedHealth’s selection of former GSK CEO Andrew Witty as the new CEO of United’s Optum unit.