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The Weekly Scan

Last Updated: 1:00 PM EST

Medicare & Medicaid

  • Apple has been in talks with at least three private Medicare plans about subsidizing the Apple Watch for people over 65 to use as a health tracker, according to people familiar with the discussions. The insurers are exploring ways to subsidize the cost of the device for those who can’t afford the $279 price tag, which is the starting cost of an older model. The latest version of the device, which includes the most extensive health features including fall detection and an electrocardiogram to measure the heart’s rhythm, retails for a minimum of $399, which many seniors could benefit from but can’t afford. The talks have not resulted in any official deals just yet, the people said. Apple has paid a visit to several of the largest insurers in the market, as well as some smaller, venture-backed Medicare Advantage plans. The people declined to be named as the discussions are still private. Apple declined to comment. (CNBC.com)

  • The CMS announced Wednesday that they recently completed a large-scale effort to provide new Medicare cards without Social Security numbers to people with Medicare. The new cards support the agency’s work to protect personal identity and reduce fraud and abuse. Over the past nine months, CMS sent new cards to more than 61 million people with Medicare across all U.S. states and territories, completing the mailing ahead of schedule. (CMS.gov)

  • The CMS issued a new proposed rule Thursday titled "Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020." This proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs). It proposes changes that would allow greater flexibility related to the duties and training requirements for the Navigator program and proposes changes that would provide greater flexibility for direct enrollment entities, while strengthening program integrity oversight over those entities. It proposes policies that are intended to reduce the costs of prescription drugs. It includes proposed changes to Exchange standards related to eligibility and enrollment; exemptions; and other related topics. (FederalRegister.gov)

  • The Medicare Payment Advisory Commission (MEDPAC) wrote a letter on Wednesday to CMS Administrator Seema Verma responding to the CMS proposed rule from November 30, 2018 titled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.” Of note, the letter states: "The Commission supports CMS’s objective of constraining growth in prices and spending for prescription drugs, which are projected to continue to outpace growth in overall health spending. In 2016, the Commission recommended a package of major changes to prepare Part D for the future while using market competition to constrain growth in drug spending. One set of changes would give plan sponsors greater flexibility to use formulary tools. A second component would give plan sponsors greater financial incentives to manage benefits by lowering Medicare’s reinsurance subsidies to plans while simultaneously increasing risk-adjusted capitated payments. Other parts of the Commission’s recommendation would exclude manufacturer discounts on brand-name drugs from counting as enrollees’ true out-of-pocket (OOP) spending, but would also eliminate cost sharing above the OOP threshold. Because enrollees who receive Part D’s low income subsidy (LIS) pay nominal cost-sharing amounts that provide little incentive to use lower cost drugs, the recommended improvements would also moderately increase financial incentives through modified LIS copayments." (MEDPAC.gov)


  • A newly public lawsuit filed by the state of Massachusetts against Purdue Pharma alleges that the company, the Sackler family (Purdue Pharma owners), and company executives misled prescribers and patients as they aimed to blanket the country with prescriptions for their addictive medications. The new filing also reveals how Purdue aggressively pursued tight relationships with Tufts University’s Health Sciences Campus and Massachusetts General Hospital — two of the state’s premier academic medical centers — to expand prescribing by physicians, generate goodwill toward opioid painkillers among medical students and doctors in training, and combat negative reports about opioid addiction. In a statement Tuesday, Purdue criticized the Massachusetts Attorney General Maura Healey’s office, which is spearheading the lawsuit, and said the complaint was “a rush to vilify” Purdue. It noted that its medications were approved by the Food and Drug Administration and regulated by the government, and that the company promoted the medications “to licensed physicians who have the training and responsibility to ensure that medications are properly prescribed.” (STATnews.com)

  • The Southern Poverty Law Center this week sued the Trump administration again for approving Kentucky’s Medicaid waiver plan a second time. Kentucky’s waiver plan, called “Kentucky HEALTH,” was initially set to take effect on July 1, 2018. But the SPLC and its partners filed their first class action lawsuit, Stewart v. Azar, in June 2018, challenging the administration’s approval of sweeping changes to Medicaid law that would endanger the health care of tens of thousands of low-income individuals and families in the state. A federal judge blocked the U.S. Department of Health and Human Services’ (HHS’) initial approval of the plan in June 2018, stating that the government acted in an “arbitrary and capricious" manner in approving it. The court found that HHS failed to adequately consider whether it would help Kentucky provide Medicaid coverage to its low-income residents. U.S. District Judge James E. Boasberg sent the plan back to HHS to reconsider it in accordance with the Medicaid Act. However, in November 2018, federal health officials announced that they had approved Kentucky’s Medicaid work requirements again, despite evidence that the plan will lead to thousands of hard-working Kentuckians losing access to vital health care coverage. The SPLC and its partners filed an amended complaint on Monday in the same court, on behalf of more than a dozen Kentucky Medicaid recipients who stand to lose their benefits. They seek to have this new approval also declared to be “arbitrary and capricious.” (SPLC.org)

  • Intermountain Healthcare is trying to take its ongoing challenge of the False Claims Act (FCA) to the Supreme Court. The Salt Lake City-based health system has asked the court to review a decision by the 10th Circuit Court of Appeals, claiming the FCA violates the Appointments Clause of the Constitution. Specifically, they've pointed to whistleblower provisions which allow individuals to file fraud claims against health systems in the place of government officials. Intermountain described the FCA as a problem that unfairly plagues the industry the way it has been applied. Individuals file 600 such cases annually, the system said in its petition. "Due to the time- and cost-intensive discovery that most FCA actions require, defendants typically move to dismiss." At issue is a six-year-old case in which Intermountain and another hospital were named as defendants regarding a cardiologist who performed procedures in both of their facilities. The cardiologist was accused of performing medically unnecessary procedures that were billed to Medicare. If upheld, that case could have broad implications across the healthcare industry. (FierceHealthcare.com)


  • FDA Commissioner Scott Gottlieb M.D. released a statement Thursday updating on the FDA's new efforts to support development of over-the-counter naloxone to help reduce opioid overdose deaths: "To encourage drug companies to enter the OTC market and increase access to naloxone, the FDA took an unprecedented step: we developed a model DFL with easy-to-understand pictograms on how to use the drug. We also conducted label comprehension testing to ensure the instructions were simple to follow. This is the first time the FDA has proactively developed and tested a DFL for a drug to support development of an OTC product...Today, we’re announcing the results of our work, including posting two model DFLs (one for use with a nasal spray and one for use with an auto-injector) and the supporting FDA review. These efforts should jumpstart the development of OTC naloxone products to promote wider access to this medicine. The model DFL contains the information (except for individual product-specific information) that a consumer needs to administer naloxone safely and effectively." (FDA.gov)

  • The Government Accountability Office (GAO) released a new report on Tuesday titled "Approaches and Challenges to Electronically Matching Patients’ Records across Providers." GAO conducted this study because health care providers are increasingly sharing patients’ health records electronically. When a patient’s records are shared with another provider, it is important to accurately match them to the correct patient. GAO and others have reported that accurately matching patient health records is a barrier to health information exchange and that inaccurately matched records can adversely affect patient safety or privacy. The 21st Century Cures Act included a provision for GAO to study patient record matching. In this report, GAO describes (1) stakeholders’ patient record matching approaches and related challenges; and (2) efforts to improve patient record matching identified by stakeholders. (GAO.gov)

#Medicaid #Medicare #Research #Litigation


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