The Daily Scan

June 28, 2018

Last Updated: 9:00 AM EST

Medicaid

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued the first-ever approval of a state plan amendment proposal to allow the state of Oklahoma to negotiate supplemental rebate agreements involving value-based purchasing arrangements with drug manufacturers that could produce extra rebates for the state if clinical outcomes are not achieved. The state plan amendment proposal submitted by Oklahoma will be the first state plan amendment permitting a state to pursue CMS-authorized supplemental rebate agreements involving value-based purchasing arrangements with manufacturers. (CMS.gov: Press Release, State Plan Amendment)

 

  • The Trump administration has rejected a request from Massachusetts to choose drugs covered by the state's Medicaid program based on cost and how well they work. The stated problem, spelled out in a letter from the Centers for Medicare and Medicaid Services (CMS), was that Massachusetts planned to keep collecting pharmaceutical rebates while excluding some drugs. The Massachusetts proposal, described as the "vanguard" of state efforts to control rising pharmaceutical costs within Medicaid, might have established a market-driven model for other programs. "This is disappointing for Massachusetts and for a lot of other states that really want to do something similar," said Matt Salo, executive director of the National Association of Medicaid Directors. "State Medicaid programs need more market leverage to be able to bring the cost of exorbitantly priced drugs down." (WBUR.org)

 

  • Brian P. Ritchie, Assistant Inspector General for Audit Services, U.S. Department of Health and Human Services, testified yesterday before the U.S. Senate Committee on Homeland Security and Governmental Affairs on the topic of "Medicaid Fraud and Overpayments: Problems and Solutions." Ritchie commented on the need to leverage national Medicaid data to implement meaningful change: "OIG has the capacity to leverage advanced data analytic techniques to detect potential vulnerabilities and fraud and better target our resources to those areas and individuals most in need of oversight. However, to date, this innovative way to enhance and strategically target our oversight efforts cannot be accomplished in Medicaid without better quality, national Medicaid data." (OIG.HHS.gov)

Legislation

  • Numerous public health scholars from institutions across the country testified yesterday to the U.S. Senate Committee on Health, Education, Labor, and Pensions on the topic of "How to Reduce Health Care Costs: Understanding the Cost of Health Care in America." Dr. Ashish K. Jha, MD MPHK.T. Li Professor at Harvard T.H. Chan School of Public Health and Director of the Harvard Global Health Institute asserted: "While our political leaders often disagree on many economic and social issues, there is unique bipartisan agreement that U.S. health care spending is too high, and fails to deliver value for money. This represents not only a major policy challenge, but also an opportunity. And while the cost of inaction is being felt in communities across our great nation, the dividends, if we get smarter about managing health care spending, will also be felt by every single American." (HELP.Senate.gov)

Regulation

  • The HHS OIG released the results of a study conducted based on the 2017 onsite inspection of the Tennessee Medicaid fraud control unit. Their review covered the 3-year period of FYs 2014-2016. The inspection was based on an analysis of data from seven sources: Unit documentation; financial documentation; structured interviews with key stakeholders; structured interviews with the Unit's managers and selected staff; a review of a purposive sample of 20 case files that were open at some point during the review period; a review of all convictions submitted to OIG for program exclusion and all adverse actions submitted to the National Practitioner Data Bank during the review period; and observation of Unit operations. (OIG.HHS.gov)

 

 

 

 

 

 

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