Medicaid Flexibility Battle Continues

 Many states are seeking more flexibility from the federal government for managing their own Medicaid programs.  Rep. Phil Gingrey (R-GA) and Sen. Orrin Hatch (R-UT) have introduced legislation, The State Flexibility Act (H.R. 1683, S. 868) that would lift the Medicaid maintenance-of-effort (MOE) provisions in the Affordable Care Act, which prevent states from putting in place stricter eligibility rules until 2014 for adults and 2019 for children.  Prospects for passage are favorable in the House, not in the Senate.  The National Conference of State Legislatures endorsed the bills last week.  Click here to read the NCSL letter. 

FTC Attacks ACO-Like Bill in Texas; Pioneer ACOs Launched

 The Federal Trade Commission is attacking new legislation in the Texas legislature that is designed to allow hospitals and physicians to work more closely together.  Read the local news story here.  Meanwhile, CMS last week launched a new ACO program through its Innovation Center.  Our policy team has written a new two-page summary of this program compared with HHS’ original ACO program attached here. 


House GOP Medicare Plan Would Dramatically Increase Seniors’ Costs: JEC

 Congress’ Joint Economic Committee is out with a new report detailing how much more seniors would pay under the House GOP Medicare plan it passed last month.  For example, in Florida, out-of-pocket costs would increase from $7,145 to $14,528; in Illinois from $6,515 to $13,248; in Oregon from $4,587 to $9,326; and in New Mexico, from $4,601 to $9,357, according to the report.  A copy of the 4-page report is here. 


New Flexibility for Certain Orphan Drugs Under 340B Program

HHS last week published a proposed rule designed to clarify the way in which orphan drugs can be purchased under the 340B program, which provides discounts on drugs for certain safety-net providers.  Under the proposed rule, orphan drugs (which are used in treating rare conditions) are excluded from covered outpatient drugs for specified newly eligible entities for 340B purposes, if the drugs are used to treat the rare ailment for which they received the orphan-drug designation. 


50 Senators Call on CMS to Ease Home Health Requirements

 Concerned that home health patients may not be getting the care they need – because of new regulatory restrictions and requirements – 50 senators signed on to a letter last week to CMS urging action.  Senator Maria Cantwell (D-WA) and Susan Collins (R-ME) are leading the effort.  You can read the details here. 


More MLR Waivers Sought

 Nine more states and Guam have applied to HHS to allow individual insurance plans to spend less than 80 percent of health insurance premiums on medical claims and quality improvements.  The latest request for an adjustment came from Indiana, which filed an application that was posted on HHS’s website May 13. Delaware requested an adjustment, which was received by HHS May 12.  In addition to Guam, other requests for adjustments have been filed by Kansas, Louisiana, Iowa, North Dakota, Florida, Georgia, and Kentucky.  Click on any of the states below to go to the HHS website that details the request and status:  Maine, New Hampshire, Nevada, Kentucky, Florida, Georgia,North Dakota, Iowa, Louisiana, Guam, Kansas, Delaware, Indiana.

The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio. It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. MLR requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the review provisions imposing tighter limits on health insurance rate increases. If they fail to meet these standards, the insurance companies will be required to provide a rebate to their customers starting in 2012. 


“Typical” Essential Health Benefits Defined in New Report 

 The debate over what consitutes Essential Health Benefits is also heating up as the government is required to define the EHB for State Exchange-sold policies.  The Affordable Care Act requires HHS to set EHB based
on the “typical” employer plan.  “Typical” is not defined.  A new report from Milliman for its client Pfizer attempts to quantify what is “typical” today.  Read the interesting 19-page report, which is attached here.