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The Daily Scan

Last Updated: 8:55 AM EST

Medicare & Medicaid

  • Yesterday, the Centers for Medicare & Medicaid Services (CMS) announced the Funding Opportunity Announcement (FOA) for the Federally-facilitated Exchange (FFE) Navigator Program for plan year 2019. The Federally-Facilitated Exchange will conduct its sixth Open Enrollment later this year. The Exchange is an established marketplace for individuals seeking insurance. CMS Administrator Seema Verma commented: “It’s time for the Navigator program to evolve, which is why we are announcing a new direction for the program today. This decision reflects CMS’ commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process.” (CMS.gov)

  • Yesterday, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation. This would eliminate states' ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. Tim Hill, Acting Director for the Center for Medicaid and CHIP services commented: “This proposed rule is intended to ensure that providers receive their complete payment, and any circumstances in which a state does divert part of a provider’s payment must be clearly allowed under the law.” (CMS.gov)

Private Sector

  • Verity Health System, a nonprofit healthcare system in Los Angeles announced an exploration of strategic options. This included potential sale of some or all of their locations, among other possible transactions. The top priority of Verity Health System is to “establish a long-term, sustainable path forward for their hospitals, which are of critical importance to the communities they serve,” said Rich Adcock, CEO of Verity Health. (Verity.org)

  • Cerner, a global leader in health care technology, and Lumeris, an award-winning health plan and value-based care managed services operator, yesterday announced a 10-year relationship aimed at eliminating inefficiencies in the current health care system. Together, they will launch and implement Maestro Advantage, as an innovative model with supporting processes and expertise to aid long-term success in value-based care arrangements. This will include Medicare Advantage (MA) and provider-sponsored health plans (PSHPs). This model has been designed to help the health system succeed with MA, and other value-based arrangements by improving the quality of outcomes and physician-patient encounters. (Cerner.com)


  • The FDA has updated the warning labels for fluoroquinolone antibiotics strengthening the awareness of risks of mental health side effects and serious blood sugar disturbances. The labels will now be consistent across all labeling for fluoroquinolones taken by mouth or given by injection. Fluoroquinolone is used in the treatment of serious bacterial infections such as certain types of bacterial pneumonia. “The FDA remains committed to keeping the risk information about these products current and comprehensive to ensure that health care providers and patients consider the risks and benefits of fluoroquinolones and make an informed decision about their use,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. (FDA.gov)


  • Yesterday, JAMA released a study on of the effect of a home-based wearable continuous ECG monitoring patch on the detection of undiagnosed atrial fibrillation. The study explored whether a home-based self-applied wearable electrocardiogram (ECG) patch can a improve the diagnosis of atrial fibrillation (AF) relative to routine care. In this study, the doctors found in a randomized clinical trial of 2659 individuals at increased risk for AF, who wore the monitoring self-applied ECG patched led to a significantly higher AF diagnosis at 4 months. Further research is needed regarding clinical implications. (Jamanetwork.com)

  • A recent study by Health Affairs analyzed specialty drug coverage decisions issued by the largest US commercial health plans to examine variation in coverage and the consistency of those decisions with indications approved by the Food and Drug Administration (FDA). Across 3,417 decisions, 16% of the 302 drug-indication pairs were covered the same way by all of the health plans, and 48% were covered the same way by 75% of the plans. Specifically, 52% of the decisions were consistent with the FDA label, 9% less restrictive, 2% mixed (less restrictive in some ways but more restrictive in others), and 33% more restrictive, while 5% of the pairs were not covered. (Healthaffairs.org)

#Research #Regulation #Medicaid #Medicare #PrivateSector


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