Medicaid waiver loophole sparks transparency concerns

May 17, 2019, Modern Healthcare, Robert King -  The CMS is doing a poor job in ensuring the public knows knows about major changes to Medicaid, including the installation of work requirements, a federal watchdog said Friday. The Government Accountability Office’s report found that the CMS has limited transparency for amendments to existing Section 1115 waivers. That has allowed some states to score approval for their work requirements while skirting some rules, such as projecting how the changes will impact Medicaid enrollment. The government watchdog noted that two of the four states it studied did not seek public comment on changes that could significantly impact Medicaid beneficiaries.  The transparency requirements for an amendment are more relaxed than a new waiver application, the GAO said. Arkansas and New Hampshire both added work requirements to their Medicaid programs through amendments to their existing Section 1115 waivers.

Mississippi Rural Health Task Force holds first meeting

May 17, 2019, WLOX, Courtney Ann Jackson -  Governor Phil Bryant is giving a charge to a newly-created Rural Health Care Task Force. He’s asking the group to consider ways to reduce the threat of more hospital closures and improve access to care. The task force chairman notes that there is no silver bullet answer but they’re hoping to find focused solutions. “We’re not here to talk about the issues that we all know exist,’ said chairman Ryan Kelly. “We all know what the problems in Mississippi’s health are. We all know we’re 50th in a lot of categories we don’t want to be 50th in. We’re not going to spend our time rehashing what we already know.”  And one topic was taken off the table for the group.  “It’s my thought that this committee, this task force should not focus on Medicaid expansion because it could eat up all of our time and we’d still be sitting here with the same problems,” added Kelly.  Still, many of the comments from members still referenced the impact of reduced Medicaid reimbursements have on the small hospitals and providers.

As ER Wait Times Grow, More Patients Leave Against Medical Advice

May 17, 2019, KHN, Phillip Reese -  Emergency room patients increasingly leave California hospitals against medical advice, and experts say crowded ERs are likely to blame. About 352,000 California ER visits in 2017 ended when patients left after seeing a doctor but before their medical care was complete. That’s up by 57%, or 128,000 incidents, from 2012, according to data from the Office of Statewide Health Planning and Development. Another 322,000 would-be patients left the emergency room without seeing a doctor, up from 315,000 such episodes in 2012.  Several hospital administrators said overcrowding is a likely culprit for the trend. California emergency room trips grew by almost 20%, or 2.4 million, from 2012 to 2017.

House passes drug pricing bills paired with Obamacare fixes

May 16, 2019, Politico, Adam Cancryn and Sarah Owermohle - House Democrats this evening passed the session’s first legislation aimed at lowering drug prices, as the party looks to solidify its political advantage on a key issue for voters ahead ahead of 2020. The health care vote - the House’s second in two weeks - came over bitter protests from Republicans, who accused Democratic leaders of politicizing once-bipartisan drug price proposals by pairing them with polarizing measures to strengthen Obamacare. The bill is unlikely to survive the GOP-controlled Senate.  But Democrats touted the package as proof they’re focused on fulfilling the campaign vows that won them the House majority, even amid the constant swirl of White House-driven investigations and intrigue.  “Health care, health care, health care. That is what is of concern to the American people,” House Speaker Nancy Pelosi said ahead of the 234-183 vote. “We’re continuing our drum beat on the prescription drug prices, on the pre-existing conditions.”
Five Republicans voted for the measure.

Trump administration backs off Medicare drug pricing rule

May 16, 2019, The Hill, Nathaniel Weixel -  The Trump administration on Thursday backed off a controversial Medicare drug pricing proposal that would have allowed insurers to exclude certain drugs if prices rise faster than inflation.  In a final rule, the administration said it was leaving in place the current policy about Medicare’s “protected classes” of drugs. Under current law, private Medicare health plans are required to cover all or “substantially all” drugs in six “protected” classes, such as HIV treatments, antidepressants, drugs to treat epileptic seizures, and cancer drugs, regardless of cost.  Last fall, the administration proposed allowing health plans to exclude protected drugs with price increases that are greater than inflation, as well as certain new drug formulations that were not a “significant innovation” over the original product.

Trump’s Talk On Preexisting Conditions Doesn’t Match His Administration’s Actions

May 16, 2019, KHN, Shefali Luthra -  Delivering remarks on surprise medical billing, which is a concern that has drawn bipartisan interest, President Donald Trump waded into another high-profile health issue: making sure insurance protects people who have preexisting health conditions. It’s natural Trump would want to make this claim. Polling from the Kaiser Family Foundation suggests that such protections, which prohibit individual insurance plans from charging people more based on their medical history, are a top priority for Americans and among the most popular provisions of the Affordable Care Act. With that context, we decided to put a microscope to the president’s claim. We asked White House staff to point us to the policies or proposals on which Trump’s statement was based. They declined to provide specifics but reiterated the president’s assertion.