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The Weekly Scan

Last Updated: 1:00 PM EST

Medicare & Medicaid

  • Today, CMS issued updated guidance to the 2014 Medicaid Home & Community Based Services (HCBS) regulation. In a tweet, CMS Administrator Seema Verma explained: "The guidance will assist states in implementing the rule, while giving families greater certainty about where their loved ones will be cared for." A letter to State Medicaid Directors proceeding the guidance explains: "The FAQs focus on settings that have “the effect of isolating individuals receiving Medicaid [Home and Community-Based Services] HCBS from the broader community of individuals not receiving Medicaid HCBS.” (Medicaid.gov; Twitter.com)


  • Following the ruling by Dane County Circuit Court Judge Richard Niess in League of Women Voters of Wisconsin v. Knudson, the Wisconsin Department of Justice moved to withdraw the State of Wisconsin from Texas v. United States. “Today, we are seeking to end the State of Wisconsin’s involvement in the lawsuit challenging the constitutionality of the Affordable Care Act,” said Attorney General Josh Kaul. Kaul filed the motion Thursday after fellow Democrat, Gov. Tony Evers, ordered him to withdraw Wisconsin from the lawsuit. Kaul had been blocked from taking action under a law passed by the Republican Legislature in a lame-duck session shortly before he took office. But a Dane County circuit judge on Thursday ruled that the laws were unconstitutionally passed, giving Evers and Kaul a window to take action. Republicans say they will appeal the ruling, which could result in a higher court putting Thursday's decision on hold. Both Kaul and Evers campaigned on wanting to withdraw from the multi-state lawsuit. (DOJ.State.WI.us, WBAY.com)

  • Low-income individuals in New Hampshire, represented by a group of health care advocates, sued the Trump administration on Wednesday challenging its approval of the State’s “Granite Advantage” Section 1115 Medicaid waiver project that conditions Medicaid health coverage on work requirements, and cuts vital services like retroactive coverage. The National Health Law Program, New Hampshire Legal Assistance, and National Center for Law and Economic Justice are representing several New Hampshire Medicaid enrollees in the third legal challenge to a state Medicaid waiver plan that includes legally suspect changes to Medicaid coverage requirements. Legal challenges are underway in Kentucky and Arkansas over similar Medicaid waiver projects. (HealthLaw.org)

  • Maryland-based MedStarHealth System agreed to pay the United States $35 million to settle allegations under the False Claims Act that it paid kickbacks to MidAtlantic Cardiovascular Associates (MACVA), a cardiology group based in Pikesville, Maryland, in exchange for referrals through a series of professional services contracts. The allegations resolved in the settlement include the payment of kickbacks to MACVA under the guise of professional services agreements, in return for MACVA’s referrals to Union Memorial of lucrative cardiovascular procedures, including cardiac surgery and interventional cardiology procedures, from Jan. 1, 2006, through July 31, 2011. Under the settlement MedStar also agrees to settle allegations that it received Medicare payments from Jan. 1, 2006, through Dec. 28, 2012, for medically unnecessary stents performed by John Wang, M.D., a one-time employee of MACVA who was later employed by MedStar. (Justice.gov)

  • Vermont's Chittenden Superior Court has denied Purdue Pharma’s motion to dismiss the State's case against it. The judge ruled that the State may bring all its claims against Purdue Pharma arising from allegations that it “aggressively and misleadingly marketed opioids such as Oxycontin in Vermont, leading to massive addiction and the resulting societal costs.” Attorney General T.J. Donovan said, “This decision is an important step toward holding Purdue responsible for its contribution to the creation of the opioid crisis.” The State’s lawsuit is based on Purdue Pharma’s behavior surrounding marketing of OxyContin and other long-acting opioid products for the treatment of chronic pain, including: minimizing the serious risk of addiction; denying or failing to disclose the dangers of opioids at higher doses, which increased the risk of addiction and overdose; overstating the effectiveness of screening tools for preventing addiction, giving prescribers unwarranted confidence that they could safely prescribe opioids; and exaggerating the effectiveness of abuse-deterrent opioid formulations at preventing abuse and addiction. (AGO.Vermont.gov: Press Release, Decision)

Research & Grants

  • On Wednesday, the U.S. Department of Health and Human Services (HHS) released an additional $487 million to supplement first-year funding through its State Opioid Response (SOR) grant program. The awards to states and territories are part of HHS’s Five-Point Opioid Strategy and the Trump administration’s tireless drive to combat the opioid crisis. Together with the $933 million in second-year, continuation awards to be provided under this program later this year, the total amount of SOR grants to states and territories this year will total more than $1.4 billion. This funding will expand access to treatment that works, especially to medication-assisted treatment (MAT) with appropriate social supports. (HHS.gov)

  • The Government Accountability Office released a new report this week titled: "Private Health Insurance: Enrollment Remains Concentrated among few Issuers, including in Exchanges." A highly concentrated health insurance market may indicate less competition and could affect consumers’ choice of issuers and the premiums they pay. Thus, the Affordable Care Act included a provision for GAO to study market concentration, made particularly important following the mandated 2014 establishment of health insurance exchanges. Through this updated study, GAO found that enrollment in private health insurance plans continued to be concentrated among a small number of issuers in 2015 and 2016. In the overall large group market (coverage offered by large employers), small group market (coverage offered by small employers), and individual market (coverage sold directly to individuals), the three largest issuers held 80 percent of the market or more in at least 37 of 51 states. This is similar to what GAO previously reported for 2011 through 2014. (GAO.gov)


  • Zoll Medical announced Tuesday that it experienced a data breach during an email server migration that exposed select confidential patient data. The data exposed included patient names, addresses, dates of birth, limited medical information and some social security numbers, the Chelmsford, Mass.-based company said. Zoll said that its email is archived by a third-party service provider and that during a server migration, some data from Zoll emails were exposed. The incident is believed to have occurred between November 8 and December 28, 2018. The company said that it has now secured all information and that it is not aware of any fraud or identity theft as a result of the breach. (MassDevice.com)

#Technology #Research #Litigation #Medicaid #Medicare


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