The Daily Scan

September 27, 2018

Last Updated: 1:00 PM EST

Medicaid

  • In a speech at the 2018 Medicaid Managed Care Summit this morning, CMS Administrator Seema Verma made the following comments on Medicaid work requirements: "...There is clear evidence that people are happier and healthier when they are working and leading independent, self-sufficient lives. Arthur Brooks of the American Enterprise Institute, wrote a book about the concept of earned success. The idea that we value what we earn much more than we value what is given to us. The drive to earn propels us to new heights, whereas dependency limits us. The problem too often is that the most well-meaning government policies trap people in a hopeless cycle of poverty, making it too difficult to escape, and too easy to become more dependent.  Instead, we ought to insist that the able-bodied participate in earning benefits. To quote from Arthur’s Book, the Conservative Heart: “Work gives people something welfare never can. It’s a sense of self-worth and mastery, the feeling that we are in control of our lives. This is a source of abiding joy. There’s a reason that Aristotle wrote “happiness belongs to the self-sufficient.” Community engagement requirements are not some subversive attempt to just kick people off of Medicaid. Instead, their aim is to put beneficiaries in control with the right incentives to live healthier independent lives." (CMS.gov)

 

  • Tennessee filed its Amendment 38 to the TennCare II Demonstration earlier this week. The introduction to the document explains: "Tennessee continually seeks to build on its history of innovation by identifying new ways to improve the TennCare program. In the proposed waiver amendment outlined below, Tennessee proposes an enhanced program design for certain members that is intended to support participants’ ability to obtain and maintain employment, promote improved health outcomes, and ultimately serve as a pathway to independence that supports program participants in their transition from public assistance to private health insurance." (TN.gov)

Medicare

  • Health insurer Aetna, Inc. said on Thursday it will sell its standalone Medicare prescription drug plan business to WellCare Health Plans, Inc. as it seeks U.S. antitrust approval for a planned acquisition by CVS Health Corp. The $69 billion CVS-Aetna deal would be the second large deal this year between insurers and pharmacy benefit managers, a consolidation the companies say will help rein in rising U.S. healthcare costs. (Reuters.com)

 

  • The Office of Inspector General of the Department of Health and Human Services released the results of an audit revealing that Etheredge Chiropractic has received unallowable Medicare payments for chiropractic services. Of the 100 services in the OIG sample, 67 were allowable in accordance with Medicare requirements, however the remaining 33 were not allowable. As a result, Etheredge received $1,042 in unallowable payments. Etheredge has stated that they disagree that 31 claims were medically unnecessary. Additionally, Etheredge that it would go through the Medicare Part B appeals process. Etheredge maintains that their audit results are valid because them, with the assistance of an independent medical reviewer, determined whether each service was allowable in accordance with Medicare requirements. (OIG.HHS.gov)

Research

  • Alex Azar, Secretary of Health and Human Services, gave an opening statement yesterday while attending the United Nations high level meeting on Tuberculosis. While welcoming all participating parties, Azar stated: “Despite being preventable and curable, TB is the leading cause of death in the world from infectious disease. So there is every reason to set ambitious targets, as we did in the U.N. declaration on TB. But achieving them will require a comprehensive response. Moving ahead, three TB objectives are paramount: increasing the number of people diagnosed and effectively treated; rapidly scaling up effective existing tools, including TB preventive therapy; and developing new tools to prevent, diagnose and cure the disease. To support these objectives, as I outlined today, the U.S. government will sustain its strong commitment to research that will lead to a more complete understanding of TB and the development of new vaccines, diagnostics and treatments.” (HHS.gov)

 

 

 

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