Noteworthy News

Archive for November, 2015


Study: Medicaid Denying Expensive Hepatitis C Drugs

A new study has found that state Medicaid programs are rejecting nearly 50 percent of requests to administer expensive hepatitis C drugs to patients. According to a review of prescription data for Delaware, Maryland, New Jersey, and Pennsylvania, 46 percent of requests for such treatment for Medicaid patients were denied. Only five percent of similar requests were denied for Medicare patients and 10 percent for those with private insurance. The study represents the first documentation of a concern raised when the expensive drugs first hit the market: that insurers would limit access to them. The U.S. Department of Health and [&hellip

House Committee Forms New Medicaid Task Force

The House Energy & Commerce Committee has created a new task force “to strengthen and sustain the critical program for the nation’s most vulnerable citizens.” According to a committee news release, the task force “…will examine the program to determine how to ensure the program is best serving the needs of those who rely on it.” The task force’s work will undoubtedly be of interest to private, non-profit urban safety-net hospitals, all of which care for unusually large numbers of Medicaid patients. For further information about the new task force, its members, and its mission, see this House Energy & [&hellip

NAUH Comments on Proposed 340B Guidance

The National Association of Urban Hospitals has commented on proposed changes in the federal program that gives qualified safety-net hospitals discounts on prescription drugs they provide to low-income outpatients. This summer, the federal Health Resources and Services Administration (HRSA) published proposed guidance that seeks to refine aspects of the program’s operations and solicited stakeholder input on its proposals. In its comment letter, NAUH addressed seven aspects of the proposed guidance: The exclusion of drugs prescribed for hospital patients upon discharge. The exclusion of drugs prescribed by physicians who are not employed by or independent contractors of hospitals. The exclusion of infusion [&hellip

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid services. According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services. State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers. Interested parties have 60 days to [&hellip

GAO: More Information Needed About Supplemental Medicaid Payments

More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO). According to the GAO, states are increasingly funding non-disproportionate share (Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients. In response to [&hellip

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