Archive for September, 2017


House Committee Looks at 340B

Are hospitals using the savings generated by their participation in the section 340B prescription drug discount program to help their low-income and uninsured patients?

That’s what the House Energy and Commerce Committee’s Health Subcommittee is asking.

Earlier this year the committee requested such information from the Health Services and Resources Administration, which runs the 340B program, and now it’s asking hospitals as well.

Specifically, the subcommittee sent five-page letters to 19 providers that participate in the 340B program asking them about:

  • the quantity of 340B-purchased drugs they dispense to Medicare beneficiaries, Medicaid beneficiaries, and those with private insurance
  • the quantity of 340B-purchased drugs they dispense to uninsured patients
  • their savings from the 340B program and how they calculate those savings
  • how much charity care they provide
  • how they use 340B savings to serve vulnerable populations

The letters address many other 340B-related issues as well.

Learn more about the Health Subcommittee’s letter by reading this news release describing this initiative and go here to view a sample letter that the subcommittee sent to selected 340B providers.…

GAO: Improvement Needed in MLTSS Oversight

The Centers for Medicare & Medicaid Services needs to improve the job it does overseeing state Medicaid programs of managed long-term services and supports.

According to a new report by the U.S. Government Accountability Office, 22 states use MLTSS programs to help qualified seniors continue living independently in the community and to save money on nursing home costs.  CMS’s oversight of these efforts, and of the use of federal funds, is inconsistent and often falls short when monitoring key considerations such as provider network adequacy, critical incidents, and appeals and grievances.

To address these concerns, the GAO recommends that CMS

…take steps to identify and obtain information to oversee key aspects of MLTSS access and quality, including network adequacy, critical incidents, and appeals and grievances.

According to the GAO report, the U.S. Department of Health and Human Services agrees with these recommendations.

Learn about MLTSS oversight, what the GAO found, how it conducted its study, and what it recommended in the GAO report Medicaid Managed Care:  CMS Should Improve Oversight of Access and Quality in States’ Long-Term Services and Supports Program, which can be found here.



The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.

Among the issues MACPAC commissioners discussed during their two-day meeting were:

  • delivery system reform incentive payment programs
  • Medicaid enrollment and renewal processes
  • managed care oversight
  • monitoring and evaluating section 11115 demonstration waivers
  • Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues.  It is a non-partisan agency of the legislative branch of government.

Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.…

What is a Hospital?

The Centers for Medicare & Medicaid Services has taken a step toward answering that question in a new, 12-page guidance document that seeks to define whether a facility qualifies as a hospital under section 1861(e) of the Social Security Act.

At the heart of the question is that law’s definition of a hospital, which includes that it is “primarily engaged” in caring for inpatients.  CMS’s guidance outlines parameters for determining whether a hospital meets this standard.

Find that CMS document here.…

MedPAC Meets

Members of the Medicare Payment Advisory Commission met last week in Washington, D.C.

Among the issues they discussed during their two days of meetings were Medicare coverage policy, Medicare coverage of telehealth services, pharmacy benefit managers and specialty pharmacies, and physician supervision requirements in critical access and small rural hospitals.

Go here to see the issue briefs and presentations that were discussed during the meeting.…