Noteworthy News

Archive for November, 2014


Administration Delays Major 340B Program Regulation

The U.S. Department of Health and Human Services has decided against releasing a long-awaited regulation that was expected to bring sweeping changes to the federal government’s 340B Drug Pricing Program. The 340B program requires drug manufacturers to sell drugs at a discount to hospitals and other providers that serve especially large proportions of low-income patients.  While providers believe the program enables them to serve more vulnerable patients at a reasonable cost, drug companies have argued that the federal government has expanded the program to include more providers and more drugs than the program originally envisioned. A spokesman for the federal [&hellip

OIG Sets 2015 Medicare, Medicaid Investigations

The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has outlined the areas where it anticipates focusing its investigative energies in 2015. Among the Medicare issues it plans to address next year are: new hospital inpatient admission criteria oversight of provider-based status the appropriateness of indirect medical education (IME) payments evaluation and management (E&M) coding practices hospital controls over wage data used in the calculation of hospital Medicare area wage indexes Among the Medicaid issues the OIG will examine are: the accuracy of state eligibility determinations quality of care, including access to preventive screenings for [&hellip

Medicaid Directors Look to the Future

The directors of state Medicaid programs met recently outside Washington, D.C. to compare notes and take a closer look at the challenges they face in the future. During the conference, sponsored by the National Association of Medicaid Directors, more than 800 participants heard nearly 40 presentation on a variety of subjects, including community health integration, behavior health services, Medicaid services for children, care coordination programs, Medicaid managed care, programs for serving the dually eligible, the opioid epidemic, delivering care to special populations, rising Medicaid costs, and more. Copies of these presentations are available here, on the web site of the [&hellip

States Face Medicaid Challenges

Fifty American states have 50 different Medicaid programs.  While no two state Medicaid programs are alike, the people who run those programs often share common concerns, problems, and priorities. The National Association of Medicaid Directors has surveyed its members on the challenges they face, their priorities, and the matters they see occupying most of their time in the coming years.  Among the areas the survey explored are: budgets Affordable Care Act implementation relationships with others in their state government, federal agencies, and regulators program integrity innovations like bundled payments, accountable care organizations, demonstration projects, delivery system reform and improvements, and [&hellip

Does ACA Get Credit for Decline of Premature Birth Rates?

Some advocates believe the Affordable Care Act is responsible for the premature birth rate falling in 2013 to its lowest level in 17 years. According to the March of Dimes, the premature birth rate fell to 11.4 percent last year, and some people in the field believe the expansion of Medicaid eligibility in many states, which enabled people with incomes of up to 138 percent of the federal poverty level to obtain health insurance and better access to care, most likely played a major role in this positive development. The key, advocates believe, is that access to care results in [&hellip

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