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In the newsletter CMS issues Medicaid Drug Rebate notices to states; Congress returns to continue health care debate, opioids; NAMD Fall meeting registration is open.

July 11, 2017
From the NAMD Desk
In This Issue

Save the Date
NAMD Fall Meeting
November 6-8, 2017
Hyatt Regency Crystal City
Register here.


Reg Update


CMS Delays Effective Date of Home Health Agencies Conditions of Participation Rule
On July 10, the Centers for Medicare and Medicaid Services (CMS) published a final rule delaying the effective date of its rule updating the conditions of participation in Medicare and Medicaid for home health agencies. The new effective date is January 13, 2018, an extension of six months.
Read the rule here.
CMS Issues Two MDRP State Notices
Recently, the Centers for Medicare and Medicaid Services (CMS) released two Medicaid drug rebate program (MDRP) notices for states.
The first notice, State Notice #181, discusses the following:
  • Provides information on the notification process for suspected errors in manufacturer-reported pricing data and unit of measure information;
  • Requests state assistance in identifying nonresponsive labelers and delinquent rebate payments;
  • Provides a reminder of the threshold for Medicaid drug rebate write-offs;
  • Provides a reminder of the State Hearing mechanism option available after a failed dispute resolution;
  • Provides information on edits to existing adjustment/dispute codes; and
  • Reiterates that MCO drug invoicing must be based on date of service, starting Q3 2017.
The second notice, State Notice #182, addresses reimbursement for hemophilia-related products and services. It states that the drug reimbursement must reflect product and ingredient cost, as well as cost of dispensing, while any ancillary supplies and services covered under state plan benefit categories should be detailed under the appropriate category.


Hill Update


Congress Returns from July 4 Recess; Health Bill Negotiations Loom in Senate
Congress returns to DC this week, after a week-long July 4 recess. Further negotiations to achieve passage of the Better Care Reconciliation Act (BCRA) remains at the top of the Senate’s agenda, though the path to 50 votes remains narrow.
One potential compromise, suggested by Sen. Ted Crux (R-TX) and receiving support from other conservative members of the Senate Republican caucus, would allow insurers to sell plans on the individual market that do not include all ACA-related consumer protections, so long as the insurer sells at least one silver-level and gold-level plan. However, the idea is facing opposition from more moderate Republicans, who are concerned that such an approach would segment off sicker populations into unaffordable plans.
Should a compromise not emerge in the weeks before the August recess, Senate majority leader Mitch McConnell (R-KY) has suggested that Republicans may need to look to Democrats to pass a bipartisan package to stabilize the individual market, setting aside other Republican health reform priorities.
E&C to Hold Hearing on State Strategies to Address Opioid Epidemic
On July 12, at 10:00 a.m. ET, the House Energy and Commerce Committee (E&C) Subcommittee on Oversight and Investigations will hold a hearing titled “Combating the Opioid Crisis: Battles in the States.” The hearing will feature state agency witnesses from Rhode Island, Virginia, Maryland, and Kentucky.
A full witness list, submitted testimony, and the hearing itself can be viewed on E&C’s website here.


In the News


Kaiser Health News: As Seniors Get Sicker, They’re More Likely to Drop Medicare Advantage Plans
A recent report by the Government Accountability Office finds that out of 126 Medicare Advantage plans, 35 had disproportionately high numbers of sicker people dropping out, adding new credence to the criticism that some health plans may leave sicker patients worse off. The report carries significant implications, as Medicare Advantage plans now treat more than 19 million patients, and are expected to grow as record numbers of baby boomers reach retirement age. Despite apprehension surrounding GAO’s findings, evidence also suggests that patients mostly switch from one health plan to another simply because of a better deal, either through cheaper or more inclusive coverage. In the words of Kristine Grow of America’s Health Insurance Plans, “We have to remember these are plans working hard to deliver the best care they can.”
Please read full article here.
FierceHealthcare Discusses the Ripple Effects of School Telemedicine Programs in Maryland
In 2014, Maryland’s Howard Country decided to leverage its recent investment in broadband to offer telemedicine services in selected schools with the aim of improving access to healthcare for students, reducing illness-related absences, and improving student educational outcomes. Inadvertently, the initiative also encouraged local pediatric practices not included in the initial rollout to test and adopt telemedicine for themselves. These practices found it problematic that a third part medical center, located in Baltimore, should provide care for their patients. As a result, in the following year the program invited any pediatric practice that had children already enrolled in one of the five schools to participate. Now, patients enjoy better-coordinated and more effective care, avoiding unnecessary travel time to and from doctor’s offices while still having access to a familiar doctor. Last year, 217 students connected to physicians through telemedicine in the schools, up from 94 in the 2014-2015 school year and 150 in the 2015-2016 school year.
To read the full article, please click here.
Trump’s Surgeon General Pick Built Reputation Fighting HIV And Opioids in Indiana, reports National Public Radio
In a recent article, NPR profiled President Trump’s recently announced Surgeon General nominee, Jerome Adams, M.D. A practicing anesthesiologist, Dr. Adams was appointed Indiana Health Commissioner by then-Gov. Mike Pence in October 2014. Four months into the job, he announced an HIV outbreak in rural Scott County, Ind., after health workers documented 26 cases of HIV there. By May 2015, the number of confirmed infections had risen to 158, spread almost entirely through injection drug use. Health workers credit Adams with persuading Pence to allow Indiana counties to create syringe exchanges to contain the spread of the disease. “We wouldn’t have syringe exchange if it wasn’t for him,” says Carrie Lawrence, a public health researcher at Indiana University who helps implement syringe exchange programs throughout the state. Adams has also since supported other state laws aimed at curbing the opioid epidemic, including a bill that increased access to the overdose antidote naloxone, and another that restricts the amount of opioid medication a prescriber may give to adult patients who have not previously taken opioids and to children. If confirmed by the Senate, Adams would be the second health official from Pence’s home state to join the Trump administration.
To read the full article, please click here.
Slow Drop in Cancer Deaths in Rural America Relative to Urban Areas, Reports Reuters
According to a new CDC report, cancer deaths in America’s rural areas are not falling as much as they are in urban areas even though the total deaths from the disease are dropping across the country. While rural areas reported fewer new cancer cases at 442 per 100,000 persons compared with 457 cases in urban areas, the CDC report reveals that for cancers associated with tobacco use (i.e., lung cancer), and for those that can be diagnosed through early screenings (i.e., colorectal cancer, cervical cancer, etc.), the rate of incidence is higher in rural areas. This discrepancy reflects the critical disparities in access to healthcare in the United States: In the words of acting CDC Director Anne Schuchat, “While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis and treatment opportunities – and that’s a significant public health problem.”
Please read full article here.


Take Note


Commonwealth Fund, How Would Repeal and Replace of the Affordable Care Act Affect Your State?
In a new interactive map, the Commonwealth Fund projects various impacts that proposed change in the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BRCA) may have on people’s health care and on state economies. Through the map, one can see the estimated number of uninsured individuals under 65 in each state by 2022; by clicking on each state, one can further access state-specific factsheets, which each include information on how the AHCA and BRCA may increase the number of uninsured, increase uncompensated care costs, jeopardize federal funding, eliminate jobs, and put lives at risk.
Please click here to view the interactive map.
Commonwealth Fund, The Financial Impact of the American Health Care Act’s Medicaid Provisions on Safety-Net Hospitals
In a new issue brief, the Commonwealth Fund examines how the AHCA Medicaid provisions, which the Congressional Budget Office estimates will reduce federal Medicaid spending by $834 billion over 10 years, will affect the financial status of safety-net hospitals. It finds that, beginning in 2020, the financial status of safety-net hospitals will deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. By 2026, total margins will drop to 0.5 percent compared with estimates under current law of 2.9 percent – representing an 83 percent reduction in net income for safety-net hospitals. Small rural safety-net hospitals and safety-net hospitals treating the largest proportion of low-income patients would be hurt the most.
Please click here to read the full brief.
Louisiana Medicaid Expansion Report
In a new report, Louisiana Governor John Bel Edwards and Health Secretary Rebekah Gee discuss the impact expanding Medicaid has had on their state. Since coverage began a year ago, more than 433,000 men and women have health care coverage under Medicaid expansion (or “Healthy Louisiana”), dropping Louisiana’s uninsured rate from 21.7 percent in 2013 to below 12.5 percent – one of the largest reductions in the uninsured rate for any state. Due to this expansion of coverage, more than 100,000 have received preventive care, including screenings for breast cancer, diabetes, and colon cancer. In addition, the expansion directly led to the creation of 1,000 new jobs while generating $4 billion in new revenues for the state’s health care providers.
Louisiana’s Medicaid expansion is notable, too, for the several innovative enrollment strategies deployed to reach already-eligible residents using existing systems. These have included:
  • Out-stationed staff: Agreements were developed with some providers that allowed Medicaid enrollment staff to work within hospitals and clinics.
  • SNAP: Louisiana became the first state in the nation approved to fast-track enrollment for qualified SNAP beneficiaries into Medicaid;
  • Auto-enrollment: Nearly 190,000 individuals who were already receiving limited services through the Greater New Orleans Community Health Connection and Take Charge+ programs were automatically enrolled into Medicaid expansion for comprehensive coverage;
  • Shelters: Following the August floods, Medicaid embedded eligibility staff into some general shelters to assist people with enrollment.
To read the full report, please click here.

Arkansas Opening for Director of Medical Services
The Director of Medical Services works under administrative direction of the Department of Human Services (DHS) Director for the Division of Medical Services (DMS), and is responsible for directing operations of the State Medicaid programs by developing and establishing work priorities, standards of performance, reviewing and approving managerial decisions, and monitoring budgetary needs and expenditures for the Division.
Full posting (closes July 31) and application here.



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