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The Weekly Scan

February 8, 2019

Last Updated: 1:00 PM EST

Medicaid

  • The Government Accountability Office released a new report on Medicaid on Monday titled: "CMS Action Needed to Ensure Compliance with Abortion Coverage Requirements." While federal law prohibits federal funding for abortions in most circumstances, state Medicaid programs are required to cover abortions in limited circumstances. CMS is responsible for monitoring state compliance with federal requirements. However, concerns have been raised about challenges women may face obtaining Medicaid coverage for abortions eligible for federal funding, as well as with abortion access more broadly. GAO was asked to review issues related to abortion access. This report examines (1) factors that may present challenges to women, including Medicaid beneficiaries, accessing abortions; and (2) federal and state information on the number of abortions eligible for federal Medicaid funding. (GAO.gov)

 

  • Montana hospitals have agreed to pay a fee to help fund Medicaid expansion as the state's share of the cost of the health care coverage increases, an official with the Montana Hospital Association said Thursday. Bob Olsen, the senior vice president for the MHA, said Gov. Steve Bullock and state lawmakers made it clear they expected industries that benefited from Medicaid expansion to help pay to continue it. State officials have estimated that hospitals statewide saw their $400 million in uncompensated care drop by half as a result of Medicaid expansion, which covered 95,000 low-income adults on Dec. 1. The MHA had hoped a referendum to increase tobacco taxes would raise the needed money, but when voters rejected Initiative 185 in November, the hospitals had to find another solution, Olsen said. The proposal calls for hospitals to pay a fee of 0.95 percent of their outpatient revenue, which includes payments for tests and outpatient procedures, but not physician or other professional charges. (TheState.com)

Litigation

  • Pennsylvania Attorney General Josh Shapiro filed a petition in Commonwealth Court on Thursday to modify the consent decrees governing the relationship between UPMC and Highmark, two of the largest health care providers and insurers in the western Pennsylvania market. The petition requests that the Court impose modifications to protect and promote the public interest by ensuring that UPMC abides by its charitable obligations to the Commonwealth of Pennsylvania. “Our petition today has a simple goal: to restore fairness to the healthcare system in western Pennsylvania and promote the public interest by ensuring patient access to affordable care and facilities which they have funded through their tax dollars,” Attorney General Shapiro said, at a news conference in Pittsburgh yesterday afternoon. “As the Chief Law Enforcement officer for the Commonwealth of Pennsylvania, it is my constitutional mandate to ensure that charitable organizations like UPMC comply with our laws governing their conduct. We have concluded that UPMC is not fulfilling its obligation as a public charity.” (AttorneyGeneral.gov

 

  • Greenway Health LLC, a Tampa, Florida-based developer of electronic health records (EHR) software, will pay $57.25 million to resolve allegations in a complaint filed by the United States under the False Claims Act alleging  that Greenway caused its users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend Prime Suite, the Justice Department announced Wednesday. In its complaint, the government contends that Greenway falsely obtained 2014 Edition certification for its product Prime Suite when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification. Among other things, Greenway’s product did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions. Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary. (Justice.gov)

 

  • United States Attorney William M. McSwain announced Wednesday that his Office has filed a civil lawsuit to prevent the establishment of a facility in Philadelphia where drug users would go to inject themselves with illegal narcotics. The suit, filed against the nonprofit corporation Safehouse and its Executive Director, Jeanette Bowles, seeks a judicial decree that Safehouse’s planned opening of one or more so-called “consumption rooms” would violate federal law. This lawsuit is the first of its kind filed in the United States. In response to the city’s opioid crisis, Safehouse announced last fall its intention to open a location for drug users to inject street-purchased heroin and fentanyl under medical supervision of Safehouse employees. While U.S. Attorney McSwain emphasized that community organizations play an important role in combating the opioid scourge, he cautioned that any response must be legal. “I recognize that we are all on the same side in this fight,” he said. “The proponents of the injection site share our goal of ending this terrible epidemic. We all want solutions that save lives, but allowing private citizens to break long-established federal drug laws passed by Congress is not an acceptable path forward.” Safehouse’s proposed consumption room would violate the federal Controlled Substances Act, a comprehensive regulatory scheme enacted in 1970. The Act makes it a felony to maintain any place for the purpose of facilitating illicit drug use. (Justice.gov)

Legislation

  • U.S. Congressman Lloyd Doggett (D-TX) and U.S. Senator Sherrod Brown (D-OH) announced patient-first legislation on Thursday that would address the prescription drug affordability crisis. Their Medicare Negotiation and Competitive Licensing Act would authorize the Secretary of Health and Human Services (HHS) to negotiate drug prices and, if drug companies refuse to negotiate in good faith, it would enable the Secretary to issue a competitive license to another company to produce the medication as a generic. Congressman Doggett said, “Let’s cut prices so that patients don’t have to cut pills in half. Our proposal responds to an American problem, rampant prescription price gouging, with an American solution—negotiation and competition. We repeal and replace the Republican-imposed law prohibiting negotiation and empower the use of generic competition to lower prices.” He continued, “While there is no wonder drug to eliminate price gouging, the cure begins by making patients’ health and security nonnegotiable. We call on President Trump to follow the advice of Candidate Trump; let’s start saving billions through ‘bidding.’” (Doggett.House.gov)

 

  • On Wednesday, Congresswoman Anna G. Eshoo (CA-18), Chairwoman of the Energy and Commerce Health Subcommittee, held the subcommittee’s first hearing of the 116th Congress to examine the impacts of the Texas v. United States court case on the Affordable Care Act (ACA) and on Americans with pre-existing conditions.“Health care was the single most important issue to voters in the 2018 election, yet the Affordable Care Act is still under attack nearly ten years after the landmark bill was signed into law,” said Rep. Eshoo. “The stakes in Texas vs. United States couldn’t be higher. If the ACA is struck down, 130 million Americans with pre-existing conditions could be denied coverage or charged higher rates; 13 million low-income Americans will lose coverage under the expansion of Medicaid; and private insurance plans will no longer be required to provide the essential benefits of mental health care, emergency services, and maternity and newborn care. This hearing helps the American people better understand what’s at stake if the ACA is struck down and lays the groundwork for the Democratic House to defend and strengthen the ACA.” Chairwoman Eshoo also announced a legislative hearing next week on three bills that will begin to reverse the Trump Administration’s "sabotage" of the ACA. (Eshoo.House.gov)

Private Sector

  • Johnson & Johnson said Thursday it will start giving the list price of its prescription drugs in television ads. The company would be the first drugmaker to take that step. The health care giant will begin with its popular blood thinner, Xarelto, said Scott White, head of J&J’s North American pharmaceutical marketing. By late March, commercials will give the pill’s list price plus typical out-of-pocket costs. The information will appear on screen at the end of the commercial and include a website where people can enter insurance information to get more specific costs. J&J’s move comes amid growing scrutiny of soaring brand-name drug prices — and follows a Trump administration proposal to require list prices in TV ads. The pharmaceutical industry opposes that, arguing few people pay the high list prices. Some people’s out-of-pocket costs, though, are based on list prices. (APNews.com)

 

 

 

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