The Daily Scan

July 27, 2018

Last Updated: 8:45 AM EST

Litigation

  • Yesterday, New York Attorney General Barbara D. Underwood and Massachusetts Attorney General Maura Healey, leading a coalition of twelve Attorneys General, filed a lawsuit challenging the Department of Labor’s Association Health Plan (AHP) Rule, which expands the criteria for forming AHPs in order to evade consumer protections and sabotage the Affordable Care Act (ACA). AHPs have a long history of fraud, mismanagement, and abuse, with millions in unpaid claims for policyholders and providers, often leading to consumer bankruptcies. “The Trump administration’s AHP Rule is nothing more than an unlawful end run around the consumer protections enshrined in the Affordable Care Act –part of President Trump’s continued efforts to sabotage our health care system,” said Attorney General Underwood. “Our lawsuit today seeks to safeguard federal protections under the ACA that help guarantee access to quality, affordable health care.” (AG.NY.gov)

Legislation

  • Yesterday, Congresswoman Jacky Rosen (NV-03) introduced a resolution that would authorize the Office of the General Counsel of the U.S. House of Representatives to intervene in a pending federal lawsuit on behalf of the House to defend the constitutionality of the Affordable Care Act’s coverage protections for people with pre-existing conditions. The resolution is co-sponsored by the Ranking Members of all House committees of jurisdiction in addition to Democratic Leader Nancy Pelosi and Democratic Whip Steny Hoyer. In June, the Trump Administration’s Justice Department effectively announced it will no longer defend key parts of the ACA that prevent insurance companies from charging more to cover pre-existing conditions or denying coverage altogether. According to the Center for American Progress, approximately 1.2 million Nevadans have a pre-existing medical condition. Last week, Senators Joe Manchin (D-WV) and Claire McCaskill (D-MO) introduced a similar Senate resolution authorizing the Senate Legal Counsel to intervene in Texas vs. United States. “I’m fighting back against this latest assault on our health care system in federal court and stepping up to ensure we defend coverage protections for my constituents and hardworking Americans across the country who have a pre-existing medical condition,” said Rosen. (Rosen.House.gov)

Medicare & Medicaid

  • Secretary of Health & Human Services Alex Azar spoke yesterday to the Heritage Foundation yesterday in Washington D.C., sharing strong opinions on drug prices, the individual insurance market, and the Affordable Care Act: "Medicaid has historically played an important role, covering low-income mothers and their children, the elderly, and the disabled. But the ACA expanded the program well beyond those populations, making it a free source of coverage for 15 million new able-bodied adults, including many without any children. In fact, the ACA offers more generous support for states to insure these populations, currently covering more than 90 percent of their costs, than it does for traditional Medicaid populations. Supporting legislation to undo those perverse incentives is a priority for this administration. But in the meantime, we want to rethink how Medicaid serves able-bodied, working-age adults, which is why we have encouraged states to consider work and community engagement requirements for these populations. For these enrollees, Medicaid should be not just a government insurance card, but a pathway out of poverty, to fuller purpose and better health." (HHS.gov)

Regulation

  • The U.S. Government Accountability Office released the results of a study yesterday examining payment risks in Medicaid managed care. In this report, GAO (1) identified payment risks; (2) identified any challenges to state oversight and strategies to address them; and (3) assessed CMS efforts to help states address payment risks and oversight challenges. To do this work, GAO reviewed findings on managed care payment risks and oversight challenges from federal and state audits and other sources. GAO also interviewed 49 state program integrity stakeholders in 10 states selected based on size, the percent of population in managed care, and geography. Stakeholders included the state Medicaid managed care office, state Medicaid program integrity unit, state auditor, Medicaid Fraud Control Unit, and an MCO. (GAO.gov)

Private Sector

  • UnitedHealthcare and Aetna Health were fined $2.5 million and $350,000, respectively, this year for violating New Jersey state health insurance laws. The fines were levied by the state’s Department of Banking and Insurance. UnitedHealthcare and its affiliates, AmeriChoice of New Jersey, Oxford Health Insurance and Oxford Health Plans, were fined in the first quarter for using non-designated providers of hemophilia services for nine months, and for failing to promptly comply with decisions of the state’s Independent Health Care Appeals Program that reverses denials of claims and authorizations for treatment. (NJBiz.com)

 

 

 

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