The Daily Scan

September 17, 2018

Last Updated: 1:00 PM EST

Litigation

  • The Association for Community Affiliated Plans (ACAP), National Alliance on Mental Illness (NAMI), Mental Health America, American Psychiatric Association (APA), AIDS United, National Partnership for Women & Families, and Little Lobbyists filed suit last week in the U.S. District Court for the District of Columbia to invalidate the short-term, limited-duration insurance (STLDI) plan rule issued last month by three federal agencies. The groups claim that "this rule will harm patients and their families as well as others in the health care system by undermining access to quality, affordable coverage, will significantly disrupt insurance markets in states across the country, and threatens to bring back abusive practices that harm consumers specifically prohibited by the Affordable Care Act (ACA)." The groups argue in their complaint that the final rule violates the plain-English meaning of “short-term” by defining it as 364 days instead of three months, as currently allowed, and “limited duration” as up to 36 instead of 12 months. The plaintiffs also argue that the rule arbitrarily reverses previous limits on these plans to create an “alternative” to ACA-compliant plans that Congress did not authorize and that violates the ACA by effectively undercutting ACA plans and making them increasingly unaffordable and unsustainable for consumers who have nowhere else to turn. (CommunityPlans.net)

Medicare & Medicaid

  • Members of a federal advisory panel expressed alarm last week that 4,350 low-income people in Arkansas had lost Medicaid coverage because they failed to show they were complying with new work requirements held up by the Trump administration as a model for the nation. "I hope these data scare the pants off people in Arkansas," said Dr. Christopher Gorton, a member of the panel, called the Medicaid and CHIP Payment and Access Commission. The chairwoman of the panel, Penny Thompson, said the data — the first for any state enforcing a work requirement — were "very concerning" and "very worrisome." The Medicaid commission — a nonpartisan agency that advises Congress, the Department of Health and Human Services and states — met in Washington on Thursday and Friday and decided to seek more information on the Arkansas program, with the aim of making recommendations later this year. (NYTimes.com)

 

  • Last week the Centers for Medicare & Medicaid Services (CMS) awarded $10 million in Navigator grant awards to 39 organizations who will serve as Navigators in Federally-facilitated Exchange states. Navigators are one of many ways individuals can get help shopping for, and enrolling in, health insurance coverage; CMS continues to expand options for individuals to enroll in coverage through partnerships with the private sector, including agents and brokers and health insurance issuers. These awards will support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for 2019. "This new direction will increase accountability and ensure the grants are effective in helping consumers find health coverage that meets their needs. We will continue to monitor the impact of these changes with the primary goal of ensuring consumers have the resources to select a health plan that best fits their needs," said CMS Administrator Seema Verma. (CMS.gov)

Regulation

  • BlueCross BlueShield of Tennessee is implementing the next phase of its clinical efforts to combat misuse and unintentional overuse of prescription painkillers. Beginning January 1, 2019, commercial coverage changes will include the removal of OxyContin from the list of covered drugs, to be replaced with drugs less likely to be abused, and the addition of a benefit for alternative pain therapy. The company hopes these changes will build on the success of its previous clinical and social efforts to reduce the supply of opioids. Positive changes from 2015 to 2018 have included 19 million fewer pills dispensed and a 26% decrease in opioid prescription claims, along with a drop in the strength of the opioids being used. (BCBSTnews.com)

Research

  • On Friday, the Substance Abuse and Mental Health Services Administration released the 2017 National Survey on Drug Use and Health (NSDUH). The annual survey comprises highly anticipated data that help provide a statistical context for the country’s opioid crisis and other behavioral health matters. "SAMHSA’s National Survey on Drug Use and Health contains annual data that provides critical information which helps us understand important concepts around mental health and substance misuse across the nation," said Department of Health and Human Services Secretary Alex M. Azar II. "President Donald Trump, Assistant Secretary Elinore McCance-Katz and I share a vision for a path forward, one that involves connecting Americans to the evidence-based treatment they need." Of note, the survey found that the number of individuals initiating heroin use decreased by more than 50% in 2017 compared to 2016, and significantly more people received treatment for their substance use disorder in 2017 than in 2016 (e.g., for illicit drug use disorder, 9.2% in 2016 to 13.0% in 2017); this was especially true for those with heroin-related opioid use disorders, from 37.5% in 2016 to 54.9% in 2017. (HHS.gov)

 

 

 

 

 

 

 

 

 

 

 

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