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The Daily Scan

Last Updated: 1:55 PM EST


  • The Arizona Health Care Cost Containment System has submitted a request to CMS which, if approved, would allow them to waive the existing requirement to pay for 3 months of coverage retroactively upon beneficiary application to the program and instead only pay for 1 month of retroactive coverage. This would result in significant cost savings, estimated at over $39 million in FY 2019. (AZAHCCCS.gov)

  • Pennsylvania legislature debated the semantics surrounding Medicaid at a budget meeting last month, struggling to define the program as “health care” or “welfare.” Some suggest that the term welfare carries a connotation that suggests abuse of the system. (Post-Gazette.com)


  • Medicare Payment Advisory Commission (MedPAC) submitted a proposal to the U.S. Congress on April 5 that, if implemented, would cut Medicare payments by 30% for free-standing emergency departments located within 6 miles of an on-campus emergency department at a hospital. (MedPac.gov)

  • A new study from the University of Texas Medical Branch proposes that a 2014 federal hydrocodone rescheduling policy change that limited dispensing has resulted in a 24% increase in opioid hospitalizations of Medicare recipients who did not have a prescription for the drug. (UTMB.edu)

Private Sector

  • Humana, Inc. announced today that they have entered into a value based agreement with select OB-GYN practices for their commercial group members with low to moderate risk pregnancies. The Humana program seeks to utilize an Episode Based Model to improve quality outcomes across their member’s perinatal episode of care. (Humana.com)

  • U.S. Surgeon General Jerome Adams has issued an advisory on the positive impact of Naloxone, commonly known by its brand name Narcan, a drug that can reverse the effects of an opioid overdose. (SurgeonGeneral.gov)

  • Providers are directing patients with end stage renal disease to commercial coverage, particularly COBRA, when they are eligible for Medicare and Medicaid because of higher reimbursement rates. The policy that allows this practice is being fought by high-profile critics including AHIP and BCBSA, who sent a formal letter to HHS Secretary Alex Azar on April 16. (AHIP.org)

#PrivateSector #Medicaid #Medicare


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