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Modern Healthcare
By April 1, state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs according to a final rule released Thursday. Medicaid programs until now have reimbursed pharmacies for prescription drugs based on the ingredient costs for the drug and a dispensing fee for filling the prescription, according to the Kaiser Family Foundation. The CMS says the change will more accurately reflect pharmacies' purchase prices.
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The Hill
A federal judge on Monday cleared the way for embattled former drug company CEO Martin Shkreli to testify before a House hearing next week. The judge issued an order modifying Shkreli's bail to allow him to travel to Washington, D.C., for the hearing. The terms of the bail, related to charges of securities fraud, had restricted Shkreli to remain in New York.
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The Hill
Donald Trump is calling for Medicare to be able to negotiate with pharmaceutical companies to lower drug prices, a policy long backed by Democrats and opposed by Republicans. The Republican presidential candidate told a crowd in Farmington, New Hampshire, Monday night that the policy would save billions of dollars before taking a shot at pharmaceutical companies, which strongly oppose the proposal.
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The Pew Charitable Trusts
Louisiana this month became the first state in the Deep South to make the politically charged decision to expand Medicaid health insurance to low-income adults under the Affordable Care Act. At least one other state — South Dakota — is expected to extend Medicaid coverage this year. But in the lead up to the November presidential election, supporters of the ACA aren't holding out much hope that more states will join in extending Medicaid coverage to more people — although the governors of Alabama, Virginia and Wyoming say they want to, as do key legislators in Maine and Nebraska.
Meanwhile, newly elected Republican Gov. Matt Bevin in Kentucky and Republican lawmakers in Arkansas are threatening to roll back or modify their states' existing expansion programs.
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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The Times-Picayune
Department of Health and Hospitals Secretary Dr. Rebekah Gee said Thursday that she is "optimistic" about federal officials approving Louisiana's plans to expand Medicaid coverage to more than 400,000 people. Gee was in Washington, D.C., with Gov. John Bel Edwards to meet with federal officials about Louisiana's plans. Many of the plans Gee is proposing to speed enrollment have been done before in other states, but they require approval by the Center for Medicare and Medicaid Services.
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Deseret News
Despite years of discussing the issue without resolution, Utah lawmakers will again take on Medicaid expansion and various plans to implement it for the thousands of Utahns who remain uncovered by health insurance. And, while some lawmakers are taking approaches that have been tried before, others are trying new things — an indication of a potential desire to bring healthcare benefits closer to Utahns who can't afford them.
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The Atlanta Journal-Constitution
Last week, GPB's "The Lawmakers" had Senate Majority Leader Bill Cowsert and Georgia Rep. Stacey Evans to talk about medical care in Georgia. But the show was stolen by Georgia Sen. Fran Millar, who predicted that, no matter what Republican protests you hear elsewhere, Medicaid expansion under Obamacare will ultimately happen.
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Alaska Dispatch News
One new report on Alaska's expanded Medicaid health care system repudiates lawmakers who raised fears about its unintended consequences, while another provides new ideas to control spending on the $600 million program. Medicaid, which covers 130,000 people, or about one of every six Alaskans, was a lightning rod during last year's legislative session, as top Republican lawmakers thwarted Gov. Bill Walker's plans to expand the program under President Barack Obama's healthcare law.
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With an emphasis on innovative initiatives and data-driven solutions, DentaQuest is partnering with health plans to fundamentally change the way oral health is delivered in America. Integrating preventive oral health programs not only offers members a wider portfolio of choice - it is also a proven driver of cost control.
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Kansas Health Institute
Kansas' largest disability advocacy group urged Gov. Sam Brownback and legislators Thursday to stop citing waiting lists for disability services as a reason to refuse Medicaid expansion. The Big Tent Coalition, which represents Kansans with all types of disabilities, said the argument is disingenuous and is being used "as a method of evading sincere debate on the merits of a customized KanCare expansion plan."
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The Sacramento Bee
Low-income Sacramento children aren't going to the dentist as much as they should, according to a report released this week. That's despite a five-year effort to bring more dentists into Medi-Cal managed care plans, expand community clinics and educate families about the importance of dental care. In Sacramento County, only 40 percent of children on Medi-Cal managed care plans use the dental services they're eligible for, compared to 52.5 percent statewide.
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MHPA
Last year, the Medicaid Health Plans of America (MHPA) and the Institute for Medicaid Innovation (IMI) received nearly 100 submissions for consideration in the annual best practices compendium. An electronic version of the compendium is now available at the Institute for Medicaid Innovation (IMI)'s landing page.
This year, we have two opportunities, as outlined below, for you to submit best practices.
CHildhood Obesity Prevent & Treatment (CHOPT) for Medicaid
The Institute, in partnership with MHPA and ACAP, was awarded an RWJF grant specific to childhood obesity prevention and treatment that we have named CHOPT for Medicaid. As part of the project, we are conducting an environmental scan (questionnaire for health plans) and soliciting examples of best practices.
The following is the timeline for participating in this project.
Jan. 29: Questionnaire & Best Practices Submission Form Emailed to Plans
Feb. 22: Questionnaire DUE
March 21: Best Practices Submission Form DUE (NOTE: Submissions from MHPA members are automatically sent for review and inclusion in the annual compendium.)
Oct. 28: Childhood Obesity Summit (D.C.)
2016-2017 Medicaid Managed Care Best Practices Compendium
The categories for this year's compendium remain the same; women's and maternal health, child health, behavioral health, long-term care and transitions of care and expansion population. However, the deadlines for submission are earlier due to MHPA's annual conference occurring in September, instead of November as last year.
The following is the timeline for this year's submission cycle.
March 1: Best Practices Submission Form Emailed to Plans
April 30: Best Practices Submission Form DUE
Sept. 21: Release of Compendium and Announcement of Awards at MHPA Conference (D.C.)
Women's Reproductive Health Project
The Institute is also leading a women's reproductive health project that is funded by the Kaiser Family Foundation. We will be administering a questionnaire developed by your colleagues at Medicaid health plans that will include an opportunity to briefly identify innovative and promising best practices, develop an issue brief, and host a policy briefing with Kaiser. We encourage your participation in the following ways:
April 12: Questionnaire Emailed to Plans
May 16: Questionnaire DUE
TBD: Kaiser and Institute Joint Policy Briefing (D.C.)
Please send your submissions and any questions to Jennifer Moore.
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MHPA
Thanks again to all who attended and who participated in this great recap of MHPA's annual conference. (download conference presentations here).
Next up: Save the date for mhpa2016 from Sept. 21-23!
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