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The Daily Scan

Last Updated: 1:00 PM EST


  • Yesterday, CMS proposed significant regulatory revisions to streamline the 2016 managed care regulatory framework. The changes reflect a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and innovation in care delivery. While the 2016 managed care final rule was a substantial and comprehensive rewrite of the Medicaid and Children’s Health Insurance Program (CHIP) regulatory structure, it included provisions that many states and stakeholders identified as unnecessarily prescriptive and as adding unnecessary costs and administrative burden to state Medicaid programs without contributing to the improvement of health outcomes. “Today’s action fulfills one of my earliest commitments to reset and restore the federal-state relationship, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said CMS Administrator Seema Verma. (CMS.gov)

  • A ballot initiative that would have continued funding Montana's Medicaid expansion beyond June 2019 has failed. But advocates say they'll continue to push for money to keep the expansion going after that financial sunset. The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren't in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That's more than twice as much cash as supporters were able to muster. The ballot measure would have tacked an additional $2 per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren't currently taxed in Montana. Part of that $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana. Unless state lawmakers vote to continue funding the Medicaid expansion, it's set to expire. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act. (NPR.org)

  • In a letter to HHS Secretary Alex Azar sent yesterday, the Medicaid and CHIP Payment and Access Commission (MACPAC) expressed concern regarding early results from Arkansas’ work and community engagement requirements and asked the administration to pause the program. Last month, the state announced that more than 4100 Medicaid expansion enrollees would lose coverage for the rest of the year—on top of the 4353 that lost coverage in September—for failing to report their work, volunteer, or job training activities under the requirements, which were approved in May and implemented in June. Arkansas was the third state to receive CMS approval for their work requirements and the first to implement them. The program requires those eligible between the ages of 19 and 49 years to log 80 hours a month; those who fail to do so for 3 months lose coverage for the rest of the calendar year. Citing the low level of reporting and subsequent drop of 8462 individuals from coverage, MACPAC said that the current process is likely not structured in a way that provides enrollees an opportunity to succeed under the requirements and, as a result, is calling for a pause in disenrollments in order to make proper adjustments to the program to promote awareness, reporting, and compliance among beneficiaries. (AJMC.com, MACPAC.gov)


  • A jury has instructed health insurer Aetna to pay an Oklahoma City family $25.5 million for denying a relative's claim for coverage for a type of radiation therapy the year before she died. The jury on Monday found that Aetna doctors didn't spend enough time reviewing Orrana Cunningham's case, The Oklahoman reported. The jury ruled that Aetna recklessly disregarded its duty to deal fairly and in good faith with Cunningham, who had nasopharyngeal cancer. Aetna is considering whether to appeal. Company attorney John Shely said the insurer tries to do the right thing. "If it's in our control to change, that's what we're going to do," Shely said. "Aetna has learned something here." An Aetna doctor denied Cunningham coverage for proton beam therapy in 2014, deeming it experimental, and two other in-house doctors reviewed and upheld the decision. (NormanTranscript.com)


  • Following comments today from Alex Azar, the Secretary of Health and Human Services, on an alternative payment model for radiation oncology, the American Society for Radiation Oncology (ASTRO) issued the following statement from CEO Laura Thevenot: “ASTRO greatly appreciates Secretary Azar’s remarks today on a forthcoming radiation oncology alternative payment model (RO-APM), and we’re pleased that a RO-APM is getting closer to reality. ASTRO has worked for many years to craft a viable payment model that would stabilize payments, drive adherence to nationally-recognized clinical guidelines and improve patient care. ASTRO believes its proposed RO-APM will allow radiation oncologists to participate fully in the transition to value-based care that both improves cancer outcomes and reduces costs. ASTRO has aggressively pursued adoption of this proposed model with the Center for Medicare and Medicaid Innovation (CMMI), and we appreciate the opportunities we’ve had to share our ideas with the agency to bring about this needed reform. While ASTRO is enthusiastic about the prospects for a RO-APM, we have concerns about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset. ASTRO recognizes that mandatory and voluntary models can take many different forms, and we look forward to working with Secretary Azar and CMMI to determine the best approach for the field of radiation oncology." (ASTRO.org, HHS.gov)

Private Sector

  • Google is expected to name a prominent hospital-system chief executive to a newly created role overseeing the technology company’s health-care efforts. David Feinberg is moving to the new Google health-care post after leading the Geisinger health system, which includes a health plan and hospital system operating in Pennsylvania and New Jersey. After The Wall Street Journal initially reported on Dr. Feinberg’s move, Geisinger, based in Danville, Pa., confirmed he was departing to take on a leadership role at Google. Geisinger said that current chief medical officer Jaewon Ryu, an emergency-room physician and former executive at health insurer Humana Inc., will become the system’s acting president and CEO on Dec. 1. Dr. Feinberg will aid with the transition and depart Jan. 3. Geisinger pioneered the use of electronic health records and other digital medical data. Its setup of integrating an insurer with a hospital system has been widely seen as a model, as more health-care companies try to blend various businesses under one roof. It has also been a leader in the broad use of genetic information to help manage and predict patients’ health conditions. (WSJ.com)

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