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Inside Health Policy (Subscription required)
CMS' final rule on adequate Medicaid provider pay rates doesn't apply to managed care, and Medicaid stakeholders disagree over whether the rule, as it stands, is sufficient to make sure Medicaid beneficiaries have the same access to care as other individuals. Jeff Myers, president of Medicaid Health Plans of America, agrees with CMS' decision to have two separate rules.
"We are continuing to examine the rule, but we believe the approach CMS has taken is correct," Myers said. "It makes the most sense as Medicaid transitions from fee-for-service with no accountability to a managed, integrated and capitated system in which the states and federal government have significant oversight capability. Managed care contracts offer the ability for states to ensure network adequacy, which only occurs with appropriate rate setting by the plans."
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The Hill
A pair of top senators lashed out Wednesday against several now-infamous drug company CEOs, including Martin Shkreli, who have been accused of price-gouging on potentially life-saving treatments. "My biggest challenge today is to not lose my temper," Missouri Sen. Claire McCaskill said. "The facts underlying this hearing are so egregious but it's hard not to get emotional about it."
McCaskill, who co-led the Senate's first hearing on drug pricing this year, directed most of her attacks against Shkreli, the 32-year-old hedge fund manager-turned-CEO of Turing Pharmaceuticals.
"This is the same guy who thought it was a great idea to pay millions of dollars for the only existing album of the Wu Tang Clan," she said, to sneers throughout the room, referring to a report on Wednesday that Shkreli shelled out $2 million for the only copy of "Once Upon a Time in Shaolin," the most expensive album ever sold.
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Modern Healthcare
Providers, patients and lawmakers in Arizona and Iowa are urging the CMS to reject Medicaid changes proposed by Republican governors. But in Michigan, the same array of stakeholders wants the CMS to allow conservative provisions to save the state's Medicaid expansion.
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Kaiser Health News
California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery. The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what's known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.
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Bloomberg
Sam Brownback is among the 19 Republican governors who have consistently refused extra federal dollars under the Affordable Care Act to expand Medicaid for the poor. A Tea Party darling, Brownback, of Kansas, also cut his state's income taxes three years ago, promising to make up the revenue through increased economic growth that never came. This year, facing a budget shortfall of more than $600 million, he decided to fill some of the gap using a strategy designed to draw more federal dollars to his state — through Medicaid.
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The Wichita Eagle
A study released Tuesday shows Medicaid expansion in Kansas could not only be budget neutral but could potentially turn into a moneymaker for the state. The study runs contrary to popular belief by some Kansas politicians who say expansion is too expensive and therefore not possible given the state's budget problems.
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South Dakota Public Broadcasting
South Dakota Gov. Dennis Daugaard is proposing a total state budget of about $4.8-billion for fiscal year 2017. Daugaard says South Dakota is in good fiscal shape overall. He says the state has balanced its budget honestly.
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Rapid City Journal
As South Dakota Gov. Dennis Daugaard considers whether to expand Medicaid coverage to more low-income South Dakota residents, he is seeking assurances the expansion can be paid for, and he may add a requirement that new recipients must have jobs. Daugaard may reveal his intentions in his budget address to the state next week, a top aide said.
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Arkansas News
Any new version of Arkansas' Medicaid expansion should include an assets test, among other restrictions, Gov. Asa Hutchinson said Tuesday. In a speech at the 2015 Arkansas Medicaid Education Conference in Little Rock, Hutchinson gave an updated list of items he wants to see included if Arkansas is to continue accepting federal money for Medicaid expansion. The state's current Medicaid expansion program, known as the private option, is slated to end Dec. 31, 2016.
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The Times-Picayune
After spending hours at a recent meeting talking about the costs of Louisiana's healthcare costs without discussing Medicaid expansion, the Senate Finance Committee now plans to prepare a report on the implications of expanding the federal program.
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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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Casper Star Tribune
Wyoming's Legislature has for several years rejected Medicaid expansion, despite studies indicating it would save the state money. Now, with the state facing a major budget shortfall, Gov. Matt Mead is recommending lawmakers expand Medicaid, arguing that accepting federal money for the program will help the state weather the economic downturn.
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Forbes
The U.S. hospital industry is back, thanks to the Affordable Care Act, with liquidity levels so improved these health facilities should weather coming shifts in government payments or employer moves to coordinate care toward outpatient services. A new report from Fitch Ratings shows the outlook for nonprofit hospitals, which make up the bulk of the nation's inpatient health facilities, have built a "solid financial cushion to absorb potential operating volatility" in 2016.
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Health Affairs via Medical News Today
In just 1 year, 112,000 people leaving jail or prison have been helped to get health care that they did not previously qualify for, according to a study published in Health Affairs. Before the 2014 Affordable Care Act, Medicaid provided benefits only to certain limited groups of low-income people, including pregnant women, children and people with disabilities.
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MHPA
"What If We Knew The Future: A Prevention Approach to Safer Use of Prescription Opioids," an RxAnte webinar presented by Michael Ross, M.D., chief medical officer, and Amie Joyce, MPH, vice president of account management at RxAnte, took place on Nov. 18.
Download the presentation.
MHPA
Click on the session names to download select presentations. You may also access them through the online version of the mhpa2015 conference app — just click on the schedule icon for the sessions. The presentations are listed in the documents section.
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