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Liver patients try to pull Burwell into debate over Sovaldi coverage restrictions
Inside Health Policy
Advocates for patients with liver disease are trying to pull HHS Secretary Sylvia Burwell into the debate over coverage of high-cost specialty drugs by asking her to convene a meeting among drug makers, plans, patients and providers to figure out how to make Sovaldi available to everyone infected with hepatitis C. Separately, the Campaign for Sustainable Rx Pricing, which represents plans and other stakeholders such as hospitals, has been trying to convene a meeting to negotiate down the price of Sovaldi, but Ryan Clary, executive director of the National Viral Hepatitis Roundtable, said the patient effort is different because it is not focused on lowering the drug's price.
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Drug Pricing News: A new service from InsideHealthPolicy.com
Inside Health Policy
Drug pricing policies have prompted a major fight among insurers, pharmacies, healthcare providers, drug makers, patient advocates and healthcare managers at the state and federal levels. The stakes are potentially huge, and you can't afford to miss a beat in the drug-pricing debate.
That's why InsideHealthPolicy.com has created Drug Pricing News — an email alert service on the latest news and developments in the fight over setting drug prices. Sign up for a free one-month trial to InsideHealthPolicy.com, and get access to Drug Pricing News.
CDC: Obamacare cut uninsured rate
The Hill
Federal health officials reported a drop in the uninsured rate this year, a sign of success for Obamacare's new coverage options. A quarterly survey by the Centers for Disease Control found that the uninsured rate among adults under 65 dropped by two points, from 20.4 to 18.4 percent, between the end of 2013 and the first quarter of this year.
Advocates claim momentum following CHIP hearing
The Hill
Advocates for children are claiming momentum after senators held an initial hearing on financing the Children's Health Insurance Program past September 2015. First Focus, a bipartisan advocacy group based in Washington, D.C., emphasized that CHIP has the "same strong bipartisan support among lawmakers as among voters."
Ask a guy who's promoting mhpa2014, MHPA's Annual Conference
Oct. 26-28 in Washington, DC
MHPA
Learn about mhpa2014 in this advice column parody written in the style of The Onion, the news satire website.
SHOWCASE
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Complex Clinical Reviews. Dependent Audits. And More.
Contact HMS today!
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Pennsylvania's tax on Medicaid MCOs — an example of what not to do?
Bloomberg BNA
States' use of healthcare-related taxes has been on the rise in recent years, as states look to satisfy the rising costs of Medicaid programs and capitalize on matching federal funds. But Pennsylvania's tax on Medicaid managed care organizations may serve as an example of what not to do for states with similar tax structures.
Impasse between Oregon officials, controversial drugmaker
goes before lawmakers
The Oregonian
The state of Oregon and the maker of a pricey new hepatitis C drug may yet have room to compromise on cost, according to a hearing of the House Health Care Committee. Oregon and Gilead Sciences, maker of a $1,000-a-pill drug called Sovaldi, have been at a widely publicized impasse on the drug's potential cost to the Oregon Health Plan.
North Carolina Medicaid office rolls out reorganization plan
News & Observer
Employees in the North Carolina Medicaid office got a look at a new reorganization plan that includes more sections and more specialized units. Rather than two sections — finance and operations, reporting to the Medicaid director — there will be five, with compliance and oversight, clinical and business information added. Additionally, the plan calls for a new three-person strategy team reporting to the Medicaid director.
North Carolina agency reviewing Medicaid expansion options
The Associated Press via WBTV-TV
North Carolina's health secretary says her agency is collecting information for Gov. Pat McCrory to offer him possible options for expanding Medicaid coverage under the federal health care overhaul. The Republican-led General Assembly and McCrory declined to accept expansion last year because they said the state Medicaid office faced large shortfalls and troubled operations.
Arkansas requests changes to 'private option'
The Associated Press via San Francisco Chronicle
Arkansas has asked the federal government to allow changes to the state's compromise Medicaid expansion that would require some participants to contribute monthly to health savings accounts and would impose new limits on transportation for non-emergency services.
Wisconsin needs $760 million more for Medicaid
St. Paul Pioneer Press
The state Department of Health Services says it needs $760 million more over the next two-year state budget to pay for current services in the Medicaid program. The new estimate was included in the agency's budget request submitted to Wisconsin Gov. Scott Walker's administration recently made public. That budget begins in mid-2015. The governor will submit a budget proposal to the legislature early next year.
Virginia: No Medicaid action in special session
The Associated Press via The Washington Post
There has been plenty of talking but little action as Virginia state lawmakers kicked off a special session to discuss whether the state's Medicaid program should expand. Republican leaders, who have stymied Democratic Gov. Terry McAuliffe's efforts to expand Medicaid eligibility since he took office in January, said they are holding a special session to discuss Medicaid expansion because they promised they would. But GOP leaders in the House made clear shortly after the lower chamber reconvened that their opposition hasn't wavered.
Virginia governor endorses a House Republican's proposal on healthcare
Richmond Times-Dispatch
Virginia Gov. Terry McAuliffe has endorsed a proposal by Del. Thomas D. Rust to use federal funds to expand healthcare coverage for uninsured Virginians through a new system that would rely on private insurance purchased through employer group plans, Medicaid managed-care policies or the federal insurance marketplace.
Michigan governor touts Medicaid expansion in re-election bid
Detroit Free Press
Republican Gov. Rick Snyder touted Michigan's successful Medicaid expansion as part of his re-election bid, saying 63,000 more low-income adults have signed up than projected this year, with less than four months left. The governor said about 385,000 enrolled since April, when the Healthy Michigan program launched. His administration had expected 322,000 signups by year's end.
Ohio inmate healthcare cut $10.3 million, mostly due to Medicaid expansion
The Columbus Dispatch
Ohio paid $10.3 million less for healthcare for prisoners in the 2014 fiscal year, mostly due to Medicaid expansion. The Ohio Legislative Services Commission reported that most of the savings resulted from the change on July 1, 2013, when Medicaid began picking up most of the inmate medical costs. That happened as a result of Gov. John Kasich's decision to expand Medicaid under Obamacare, a decision opposed by state lawmakers.
Obamacare helps slash hospital charity costs in Washington state
The Seattle Times
Washington hospitals provided nearly $154 million less in charity care in the first half of this year than in the first half of 2013, in many cases boosting the hospitals' bottom lines. Hospitals attributed the plunge in charity care — about 30 percent — to the Affordable Care Act's focus on reducing the number of uninsured patients.
Sunshine Health awarded Commendable Accreditation from NCQA
PRNewswire via Digital Journal
Sunshine Health, a subsidiary of Centene Corporation, was elevated to Commendable Accreditation by the National Committee for Quality Assurance for its Medical Managed Assistance and Child Welfare programs. NCQA evaluates how well a health plan manages all parts of its delivery system — physicians, hospitals, other providers and administrative services in order to continuously improve the quality of care and services provided to its members.
Read more: http://www.digitaljournal.com/pr/2196794#ixzz3DhCrrJnI
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Who's paying the new Obamacare tax? You
Kaiser Health News via USA Today
When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 — the first time the new tax is being collected — the industry is getting help from an unlikely source — taxpayers.
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CMS delays termination of MA, PDP plans with persistent low star ratings
Inside Health Policy
CMS is delaying for one year terminations of Medicare Advantage and prescription drug plans with persistent low performance ratings because it worries that the Star Ratings Program may disadvantage plans with unusually large numbers of poor enrollees, according to an agency memo.
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Democrats borrow a GOP idea on healthcare costs
The Associated Press via
The Washington Post
Borrowing a Republican idea, a group including former senior Obama and Clinton advisers, is unveiling a novel proposal to let states take the lead in controlling health costs. Individual states would set their own targets to curb the growth of healthcare spending. If they succeed, they'd pocket a share of federal Medicare and Medicaid savings, ranging from tens of millions to $1 billion or more, depending on the state.
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Did you miss Webinar Wednesday?
MHPA
For questions or to request a copy of "Managed Medicaid Highlights: Approaches to Integrated Payment and Delivery Reform and Dual Eligibles," please email Ryan Urgo. To learn more about Lilly, please visit us www.lilly.com or newsroom.lilly.com/social-channels.
Sept. 24 Webinar Wednesday: 'Federal Government Oversight of Medicaid at the State Level and How Health Plans Can Prepare' by Cody Consulting
Cody Consulting
Medicare Advantage plans are very familiar with the stringent requirements placed upon them by CMS, including the immediate actions and sanctions that can occur when compliance violations are identified through their auditing process. Cody Consulting will provide background on CMS' oversight of Medicare Advantage plans. More importantly, we will discuss why the federal government is expected to have more oversight of Medicaid at the state level in the near future.
Missed our previous issues? See which articles your colleagues read most.
Aetna job opportunities
Aetna
The following are job opportunities from Aetna. Visit here, and enter Req # for full description and details.
MD/Psychiatrist; Newark, Delaware; Req# 19223BR
This successful candidate will become the Delaware Physicians Care (DPCI) Medical Director for Behavioral Health and will serve as our expert physician resource in the areas of utilization management, quality management, case management and overall medical management. This critical role sits at the intersection of behavioral and physical health services in helping DPCI to develop holistic programs to improve the quality and outcomes of our constituent members.
MD/Physical Health; Newark, Delaware Req# 19166BR
The position entails duties and responsibilities of Medical Director for Delaware Physicians Care (DPCI). The successful candidate will serve as a critical contributor to the DPCI medical management team in the role of clinical expert to the various functional areas including utilization management, case management and quality management. A key component of this position is to use the clinical credentials, experience and judgment in rendering benefit determinations based on medical necessity.
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