CMS has issued a proposed regulation that makes smaller changes to the standards states meet when running their Medicaid plans. The proposed rule would give states some new flexibility in setting rates for their managed care plans and ensuring insurance companies have adequate provider networks. The CMS worked with Medicaid directors to develop the proposal. “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,” CMS Administrator Seema Verma said in a statement.
HHS wants to cancel its plans to postpone imposing new ceiling prices for the 340B drug discount program. The agency issued a proposed rulemaking on Wednesday that suggested the long-delayed rule will now be effective Jan. 1, instead of July 1, 2019, as originally announced earlier this year.
HHS has delayed the effective date of the ceiling price rule five times, which would cap the prices drugmakers can charge hospitals that participate in 340B. The American Hospital Association and several other medical trade groups sued the agency last fall to force it to publish the delayed regulations.
State proposals to allow residents who don’t qualify for Medicaid to buy into the program are gaining steam, but providers are concerned that could cut deep into state budgets, drive physicians out of Medicaid’s already-skimpier networks and shift more costs to the commercial insurance market.
Providers’ worries about state Medicaid buy-in options are similar to their unease over the “Medicare for all” plan pushed by Sen. Bernie Sanders (I-Vt.), which is gaining steam with progressive Democrats in Congress.
The CMS has tweaked one of its coverage processes to ease access to medical devices. There are two Medicare coverage types, one that allows national coverage and one that allows Medicare contractors to pay for services or items on a local or regional basis. The agency has modified the latter.
To get health care costs under control, we must restore market forces and equip patients to be involved in their care. That means empowering the doctor-patient relationship, which benefits not just the patient’s health, but also the patient’s pocketbook. Currently, practice, laws and regulations work to keep the power and money surrounding health care decisions in the hands of bureaucrats, lawyers and lobbyists. That is wrong.
HHS wants insight from private companies like venture capital firms and startup incubators on strategies to accelerate investment, innovation and research in healthcare.
The agency on Wednesday announced the formation of the Deputy Secretary’s Innovation and Investment Summit, a yearlong collaboration with HHS officials and various private healthcare companies and investors. The creation of the summit is in response to a request for information HHS posted in June on ways it can work with “those focused on innovating and investing in the healthcare industry.”
Congressional appropriators on Thursday approved $90.5 billion in HHS appropriations in a spending package that includes $3.8 billion in opioids funding. Congress designated $1.5 billion of the opioid funds to state response grants to replace the $500 million from the 21st Century Cures Act due to expire in May of 2019. The funding comes as the Senate heads for a Monday vote on its major opioids package.
HHS Secretary Alex Azar on Thursday touted the CMS’ recent push for accountable care organizations to assume more risk.
In an address to an advisory group on physician-focused payment models, Azar said the Center for Medicare & Medicaid Innovation would be launching “bold” new models to reform value-based models that include making physicians and hospitals into “accountable navigators of the health system.”
HHS wants to encourage providers to enter value-based care agreements with each other, and it’s researching whether it can offer new legal protections for those arrangements.
The CMS is ratcheting up scrutiny of state Medicaid programs.
The agency announced Tuesday that it is boosting audits to confirm that Medicaid beneficiaries are correctly identified as expansion or pre-expansion enrollees. States receive higher federal match rates of around 90% for expansion enrollees, while the match rate can be as low as 50% for pre-expansion enrollees.
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