Walmart In Preliminary Talks To Buy, Partner With Humana.
The Wall Street Journal (3/29, A1, Mattioli, Nassauer, Subscription Publication) reports that Walmart Inc. is in early talks to buy Humana Inc. The Journal calls the news the latest of a series of large transactions in healthcare services, following CVS Health’s agreement to buy Aetna and Cigna’s purchase of Express Scripts Holding Co.
USA Today (3/29, Schneider, Jones) reports that there is no guarantee that a deal will be finalized. USA Today adds, “For Walmart, buying Humana would be another volley in its ongoing battle with online giant Amazon, which is reportedly considering selling prescription drugs.”
Bloomberg News (3/29, Tracer, Hammond) reports that the two are discussing “a closer partnership to provide health care to consumers at home and prevent illness, according to a person familiar with the matter.” The article continues, “Walmart and Humana have explored a wide range of options including a merger, though an outright combination isn’t likely at this point, said the person, who asked not to be identified discussing private information.”
Legislation and Policy
Iowa’s Attempt To Offer Health Benefit Plans Considered Another Test Of States’ Ability To Circumvent ACA Rules.
The Wall Street Journal (3/29, Mathews, Subscription Publication) reports Iowa Gov. Kim Reynolds (R) intends to sign a bill which would allow small businesses to offer health benefit plans that do not meet ACA requirements. Wellmark Blue Cross & Blue Shield would administer the plans, which the state says are not actually health insurance. The article says this move would be the latest attempt by a state to skirt the ACA’s rules. Earlier this month, CMS warned Idaho that its plan to offer non-ACA compliant coverage violated the healthcare law.
Public Health and Private Healthcare Systems
House Lawmakers Express Concern About Proposed Changes To Medicare Advantage, Part D Plans.
Fierce Healthcare (3/29, Stankiewicz) reports that House lawmakers from both parties are worried “about proposed policy and payment changes in the Medicare agency’s 2019 advance notice for Medicare Advantage and Part D programs.” As a result, they wrote to CMS Administrator Seema Verma, listing “numerous concerns regarding the advanced notice, which was released in two parts in late 2017 and early 2018, including risk-adjustments and cost plan transitions.” The article says the lawmakers want CMS “to work with health plans in order to receive the most robust feedback and understand the full impact of the changes.”
America’s Health Insurance Plans Asks CMS To Update Medicare Advantage Payment Formula.
Healthcare Finance News (3/29, Morse) reports America’s Health Insurance Plans is urging the Centers for Medicare and Medicaid Services to revise the way it calculates payment rates for Medicare Advantage. The request comes ahead of a final notice from the agency due Monday. AHIP “said it strongly believes CMS should update its benchmark calculation in the 2019 final notice.” The article mentions that the “Medicare Payment Advisory Commission has also recommended that CMS revise the calculation of benchmarks.”
Judge Wants AHA To Submit Suggestions About How HHS Can Reduce Medicare Billing Appeals Backlog.
Modern Healthcare (3/29, Dickson, Subscription Publication) reports US District Judge James Boasberg wants the American Hospital Association to submit “ideas on how HHS can work its way through its Medicare billing appeals backlog.” The article says “Boasberg reportedly expressed frustration toward HHS during a hearing last week over the agency’s inability to find a solution for the staggering backlog.” Data show that as of June of last year, “the Office of Medicare, Hearing and Appeals (OMHA) had 607,402 appeals”; that number is expected to increase to 950,520 by the end of Fiscal Year 2021. The piece adds that the AHA sued HHS over the backlog in 2012. Modern Healthcare also mentions that recently, “the Council for Medicare Integrity, which represents RACs [Recovery Audit Contractors], sent a letter to HHS Secretary Alex Azar asking him to allow RACs to audit more claims.”
Senate Approves Bill That Would Ban TennCare From Funding Abortion Providers.
The Tennessean (3/29, Buie) reports that on Thursday, Tennessee’s Senate “voted 24-2…to ban any TennCare funds from going to health care providers that perform elective abortions.” The article says the bill “would direct the state to seek a waiver from the federal Centers for Medicare and Medicaid Services in order to exclude elective abortion providers from receiving TennCare funding.”
The Chattanooga (TN) Times Free Press (3/29, Sher) reports that Tennessee’s House already approved the measure, which is “aimed specifically at Planned Parenthood of Tennessee.”
Blue Cross’ Contract Stalemate With Texas Health Could Force Clinicians, Hospitals Out Of Network.
The Dallas Morning News (3/29, Rice) reports Texas Health Resources, Texas’ “largest health insurer,” still is “stalemated” over contract negotiations “that could impact about 185,000 consumers if not resolved by Saturday.” According to the News, more than 800 clinicians and 29 hospitals “could become out-of-network for Blue Cross Blue Shield of Texas members.” The dispute recalls a similar scuffle “played out in the public eye at the end of 2016,” but “spokesmen for both Blue Cross and Texas Health told The Dallas Morning News this week that – at least for now – ‘We’re still talking.’”
Overprescribing Of Psychotherapeutic Medication For Children On Medicaid, CHIP May Be Due To Provider Shortage, Study Suggests.
Modern Healthcare (3/29, Dickson, Subscription Publication) reports that “physicians may be overprescribing psychotherapeutic medication to children on Medicaid or CHIP,” according to a new CMS study which found that the US has “a shortage of child psychiatrists, and many don’t accept Medicaid.” Data show “24.9 million prescriptions were filled in 2009 for children diagnosed with disruptive behavior disorders, costing Medicaid $2 billion.” That figure represents a nearly 28-percent increase “from 19.5 million prescriptions for $1.62 billion in 2006.” In addition, psychotherapeutic drug claims accounted for “30% to 40% of prescription claims, but over half of prescription costs of all drug claims for children in Medicaid and CHIP.”
Colorado Republicans’ Effort To Impose Medicaid Work Requirement Fails.
The Denver Post (3/29, Paul) reports a Republican effort to add a work requirement for Colorado’s Medicaid recipients failed in the GOP-controlled state Senate Health and Human Services Committee Thursday after its first hearing. The proposal had drawn “outrage along the way from Democrats and people enrolled in the health care program.” The bill failed by a 3 to 2 vote, with state Sen. Beth Martinez Humenik, “an Adams County Republican in a vulnerable district,” casting the decisive vote.
Missouri Legislators Approve Increased Budget Mainly To Fund Higher Medicaid Costs.
The AP (3/29) reports that Missouri legislators “have approved an additional $700 million of spending this year, primarily to fund higher-than-expected costs in…Medicaid.” The article says the Senate approved the supplemental budget bill on Thursday, and sent it to Gov. Eric Greitens (R).
BCBS Adopts New Opioid Prescribing Standards.
Modern Healthcare (3/29, Kacik, Subscription Publication) reports the Blue Cross and Blue Shield Association “has adopted a new standard that opioids should not be the first or second treatment options to manage pain” in most cases, mirroring guidelines set by the Centers for Disease Control and Prevention. Chief medical officer Dr. Trent Haywood said, “The opioids are half as effective but two to four times more harmful,” adding that “because of how they are marketed, physicians might think that is not the case.”
The Winston-Salem (NC) Journal (3/29, Craver) reports the insurer announced the policy changes will go into effect on Sunday. Initial prescriptions for more than seven days will automatically be rejected except when “clinically indicated and appropriate,” the article says.
Verma Declines To Say If Work Requirements Are Better For States Which Expanded Medicaid.
The AP (3/29, Mattise) reports that CMS Administrator Seema Verma “has declined to say whether imposing work requirements on certain beneficiaries is better suited for states that expanded Medicaid than those that didn’t, saying her agency is assessing state proposals case-by-case.” On Thursday, Verma said that work requirements seek to help consumers rise out of poverty.
Also in the News
Former VA Secretary Speaks Out After Being Ousted.
The New York Times (3/30, A14, Fandos, Subscription Publication) reports, “President Trump’s dismissal of David J. Shulkin, the secretary of veterans affairs – and the nomination of a Navy doctor with no known policy views to take his place – has brought renewed focus to an increasingly contentious debate over whether to give veterans the option of using the benefits they earned through military service to see private” physicians instead of “going to government hospitals and clinics.”
In an opinion piece, Shulkin wrote in the New York Times (3/28, Subscription Publication) that privatizing the VA’s healthcare system would hurt veterans. Shulkin argued that “privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”
The AP (3/29) reports Shulkin said in the op-ed that he was removed because advocates of privatization saw him as an obstacle to the changes they wanted to make. He also said in the op-ed that there is a “toxic” and “subversive” environment in Washington, DC.