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The Daily Scan

A note to readers—In order to better serve you with a more carefully curated overview and more in-depth analysis of the day's healthcare reimbursement news, our editorial team has decided that effective September 17th, 2018, FHASTpulse will be published daily at 1:00 PM EST instead of 9:00 AM EST. We sincerely appreciate your feedback and continued support.

Last Updated: 8:55 AM EST

Medicare & Medicaid

  • CMS Administrator Seema Verma spoke yesterday at the Financial Times Pharma Pricing and Value Summit in New York City. Of note, she commented on Medicare Part D plans: "As the Secretary [HHS Secretary Alex Azar] explained this morning, we currently stand at a crossroads. Either we can move to a more dynamic and competitive market, which will lower prices while protecting patient choice, or the market we see today will be eroded by government intervention. I have many tools at my disposal to bolster competition, and I am not waiting – through regulatory changes, CMS has already strengthened competition in the market for prescription drugs, and we are continuing to take action. CMS intends to give Part D plans more leverage in their negotiations and more flexibility in their benefit design, so that they can continue to drive towards lower costs and higher quality for our beneficiaries. I want Part D plans to have every tool that plans in the commercial market have to lower costs and increase quality, and our Administration has taken a series of steps to get there." (CMS.gov)

  • HHS Secretary Alex Azar acted under his authority in the Public Health Service Act and Social Security Act in declaring the public health emergency in North Carolina and South Carolina on September 11, 2018 and in Virginia on September 12, 2018, authorizing flexibilities to support CMS beneficiaries. These actions and flexibilities are retroactive to September 7, 2018 in North Carolina and September 8, 2018 in South Carolina and Virginia. SNF care without a 3-day inpatient hospital stay will be covered for beneficiaries evacuated from a nursing home in the emergency area, discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or who need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the disaster. In addition, CMS will recognize special circumstances for beneficiaries who, prior to the current disaster, had been recently discharged from an SNF after utilizing all of their available SNF benefit days. (CMS.gov)

  • A bipartisan group of U.S. Senators sent a letter to CMS Administrator Seema Verma on Wednesday in an effort to urge the Centers for Medicare and Medicaid Services (CMS) to expand the Medicare Advantage Value-Based Insurance Design (MA VBID) model to help combat the opioid epidemic. The letter explains: "We believe the Center for Medicare & Medicaid Innovation (CMMI) is well positioned to enhance access to evidence-based opioid treatments among older Americans and people with disabilities through the MA VBID model...Given the ongoing opioid epidemic, adding substance use disorders to the list of specified clinical conditions identified for the MA VBID model is not only sensible, but imperative to meet the health care needs of people with Medicare affected by this crisis." (Aging.Senate.gov)


  • Maryland Attorney General Brian E. Frosh filed a lawsuit yesterday in the U.S. District Court for the District of Maryland against the Trump Administration, seeking a declaratory judgment that the Affordable Care Act (ACA) is constitutional and the federal government must stop taking actions to dismantle it. The Attorney General's office announced the law suit in a press release yesterday asserting: "Elimination of the ACA would imperil the health of millions of Marylanders, wreak havoc on our state budget, and destabilize Maryland’s health insurance markets and health care system." Attorney General Frosh’s lawsuit follows the Trump Administration’s refusal to defend the ACA in a Texas case that seeks to dismantle the law. “We cannot allow President Trump and Attorney General Sessions to destroy the ACA,” said Attorney General Frosh. “Their attempts to sabotage this life-saving law and jeopardize the health of Marylanders who rely on it cannot stand. We are taking action to protect and ensure health care coverage for every Marylander and all Americans.” (MarylandAttorneyGeneral.gov)

  • Chief U.S. District Judge James K. Bredar sentenced Konstantin Bas of Brooklyn, New York, and co-conspirator Mubtagha Shah Syed of Jersey City, New Jersey, yesterday to a year and a day, and three months in prison, respectively, each followed by three years of supervised release, for a scheme in which a Maryland pain management practice referred urine specimens to Bas’s testing lab in return for $1.37 million in kickbacks. Each month from April 2011 through July 2012, Advanced Pain Management Services (APMS)/American Spine Center (ASC) referred between 700 and 1,300 patient urine specimens to Accu Reference in return for kickbacks. APMS/ASC required patients who were prescribed pain relief medications to submit urine samples for testing in order to monitor the levels of pain medication or other narcotics in their bodies. Accu Reference received approximately $4.4 million in payments from claims submitted to Medicare and private insurers for testing the specimens submitted by APMS. (Justice.gov)

#Litigation #Medicaid #Medicare


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