Archive for January, 2020


CMS Introduces New Approach to Medicaid Block Grants

States would be able to convert part of their Medicaid programs into block grants under a new program introduced by the federal government.

The program, which the Centers for Medicare & Medicaid Services calls “Healthy Adult Opportunity,” would encompass services only for adults under the age of 65 who are not eligible for Medicaid because of disability or the need for long-term care, services, and supports and who are not otherwise eligible for the pre-Affordable Care Act Medicaid program.

Under the program, states can develop either a total expenses model or per enrollee model for their block grants and would have expanded opportunities to introduce co-pays and deductibles, impose work requirements, expand eligibility criteria, and waive retroactive coverage and hospital presumptive eligibility requirements.  To save on the cost of prescription drugs, they would be empowered to implement limited drug formularies.

The new program appears to be targeting states that did not expand their Medicaid programs under the Affordable Care Act.  It also appears to be CMS’s attempt to introduce the block grant concept in a limited way in the hope that it will be successful and lead to demand to expand block grants to the entire Medicaid program and not …

Supreme Court Lifts Public Charge Rule Ban

The U.S. can now reject visa and green card applicants based on their financial prospects after a new Supreme Court ruling this week.

This ruling has potential long-term implications for health care providers.

Last August a new Department of Homeland Security regulation took effect that authorized the federal government to reject immigrants’ applications for visas and green cards if their financial situation and employment prospects suggested that they might become a “public charge” and dependent on government safety-net programs like Medicaid and food stamps.  A number of groups sued to prevent the rule’s implementation and federal courts imposed an injunction against its enforcement but now the Supreme Court has lifted the last of these injunctions.

The Supreme Court’s ruling, however, did not address the merits of the public charge rule.  Instead, the court concluded that the lower courts that imposed the injunctions had overstepped their authority.  As a result, lower courts will continue to hear individual suits challenging the rule.  Meanwhile, the State Department and Department of Homeland Security will enforce it.

In 2019 the State Department rejected 12,000 visa applications.  In 2016, it rejected only 1000.

The public charge regulation poses a challenge to health care providers amid anecdotal …

GAO Finds Obstacles to Treatment for Opioid Abuse

Several obstacles get in the way of Medicaid patients receiving treatment for opioid use and addiction.

So concludes the U.S. Government Accountability Office in a recent study.

According to the GAO, the barriers to Medicaid patients receiving medication-assisted treatment for opioid use and addiction – a combination of behavioral therapy and certain medications – include:

  • The failure of state Medicaid programs to cover such services. GAO found that 40 percent of state Medicaid programs do not cover certain drugs widely used to treat opioid addiction.
  • Prior authorization requirements can slow the process of patients receiving the treatment they need.
  • Some states require providers to purchase the drugs used in medication-assisted treatment and providers are unable or unwilling to cover those costs and the risk of receiving inadequate reimbursement.
  • Some providers have been unwilling to obtain federal approval to prescribe or administer buprenorphine, an important medication-assisted treatment drug, because of the training involved before such waivers are granted or because nurse practitioners and physician assistants cannot find a qualified physician willing to supervise their efforts.

In its report, the GAO recommends that the Centers for Medicare & Medicaid Services address these challenges.  CMS agreed with these recommendations.

Learn more about the …

340B Doesn’t Drive Up Hospital Drug Spending, MedPAC Says

Hospitals do not prescribe more expensive drugs because they know the 340B program will help pay for them.

That is the conclusion drawn in a recent analysis by the Medicare Payment Advisory Commission.

Prescription drug spending has risen markedly in recent years and the pharmaceutical industry maintains that part of that increase can be attributed to hospitals that participate in the section 340B prescription drug discount program, which requires pharmaceutical companies to give discounts to hospitals and other selected providers that care for especially large numbers of low-income patients.

A new analysis by the Medicare Payment Advisory Commission, however, concludes that any such effect is minimal.

340B discounts are available for qualified patients receiving drugs on an outpatient basis, and the program’s greatest costs are associated with drugs to treat cancer.  MedPAC found that prescribing decisions “appears to be specific to the type of cancer” and concluded that “…we are unable to attribute these findings to incentives created by 340B discounts” and that “Overall effects on cost sharing for cancer patients is likely to be small, if any, depending on cancer and the patient’s supplemental coverage.”

MedPAC warns that the empirical evidence underlying its analysis was limited.

Learn more about …

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s January agenda were:

  • The Medicare prescription drug program (Part D):  status report and options for restructuring
  • Redesigning the Medicare Advantage quality program:  initial modeling of a value incentive program
  • Hospital inpatient and outpatient payments
  • Physician payments
  • Outpatient dialysis payments
  • Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments
  • Hospice and ambulatory surgery center payments
  • The 340B program
  • ACO beneficiary assignment

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.…