Legislative/Judicial/Regulatory Updates
 The Centers for Medicare & Medicaid Services (CMS) issued a final and a proposed regulation on Nov. 15. One finalized a rule requiring hospitals to make their standard charges public and the proposed rule would require both the employer and the individual and small group market insurers to disclose the rates they negotiate with hospitals and doctors. Read the Academy alert.
The U.S House of Representatives passed H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act of 2019, on Dec. 12 that would focus on efforts to lower prescription drug costs through direct negotiation between CMS and pharmaceutical companies, among other measures.
CMS granted Section 1115 waivers to South Carolina on Dec. 12 and to Wisconsin on Oct. 31, allowing the states to implement work requirements for certain Medicaid recipients.
CMS’ Office of the Actuary released its study on total national health care expenditures from 2018, illustrating official estimates of total spending through private health insurance, Medicare, Medicaid, and out-of-pocket spending. The report demonstrates that health care spending grew at a rate of a 4.6 percent with an increase to $3.6 trillion, or $11,172 per person.
CMS released the “HHS Risk Adjustment Data Validation (HHS-RADV) White Paper” on Dec. 6. In the white paper, the Department of Health and Human Services (HHS) stated it is considering potential modifications to four aspects of the risk adjustment data validation (RADV) program: enrollee sampling; outlier detection; the error rate calculation, and the application of HHS-RADV results. Read the white paper here.
The Virginia Medicaid Director formally asked the Trump administration to halt finalizing the state’s application for a Medicaid work requirement as the state plans to remove this requirement.
Legal aid groups in Michigan filed a lawsuit on Nov. 22 against HHS and CMS to block Medicaid work requirements in the state, which are scheduled to go into effect in January. Medicaid work requirements have been blocked so far in Arkansas, Kentucky, and New Hampshire.
Tennessee sent a request to CMS to convert its Medicaid program into a limited, block grant-style model in exchange for new flexibility on Medicaid benefits.
|
