Medicaid, CHIP, Exchange RegsMake Major Changes

CMS has issued 450 pages of proposed regulations adding significantly more detail to how state health Exchanges will work with Medicaid and the Childrens Health Insurance Program (CHIP). Our policy team has put together an excellent summary of the regs. This 5-page summary is a must-read for anyone needing information about how enrollment and eligibility issues for Medicaid and CHIP beneficiaries in Exchanges. Click here for the summary. The cost sharing section of the summary was amplified by a report last week in the NY Times (click here). The story said a family of three with annual income of $30,000 could be required to pay $1,500 in premiums and co-payments.

GOP Challenges “Inaccurate” CMS Data that Could Hurt Exchanges

CMS’s ability to run Exchanges is being questioned by congressional  Republicans who are taking HHS to task for providing “inaccurate” information to the GAO about private Medicare Advantage plans. In a letter to the HHS secretary, they are skeptical of CMS’s ability to give out accurate information consumers will need when they start signing up for the health exchanges in October. Click here for a copy of the 3-page congressional letter. Meantime, a bipartisan majority of the public supports the creation of Exchanges. Click here for the Kaiser Poll.

Major Insurers Not Yet Committing to Exchanges – But Making Significant Profits

Health insurance company WellPoint said last week it has conducted “extensive research” and investment around product design and structure of plans for the forthcoming health insurance exchange marketplace and may participate in the 14 states where the insurer’s Blues plan operate. The company also announced a big increase in 4th quarter net income. Click here for the report. United Health Group also announced a strong 4th
quarter on the earnings front, according to reports last week. United also said it is making no commitment to participating in state Exchanges at this time and questioned whether Exchanges will be enrolling large numbers of individuals or groups by September. Click here to read comments from United’s CEO.

Moody’s Says Hospital Outlook Negative

While insurers may be doing well, the outlook for not-for-profit hospitals in 2013 continues to be negative, according to Moody’s Investors Service. Although revenue growth will remain positive, Moody’s expects the rate of this growth to diminish. Click here for the Moody’s report.

New Health Plan Pits Employers Against Providers

A new health care plan just being introduced in Cincinnati has some workers facing the threat of new medical bills. At least nine Cincinnati-area employers with more than 5,000 employees already have signed up for the new plan, called TrueCost. Employers who fund their own health plans say it allows them to manage or even reduce health care costs because payments are set at Medicare rates plus a 40% “provider bonus.” But hospitals and doctors insist they didn’t negotiate the payments, won’t honor the plan and will send bills to patients for their full charges. Click here for the USA Today story.

Major Insurer Expanding PCMH Program

Based on the success of its one-year pilot program, health insurer Highmark Inc. announced today that it is expanding its patient-centered medical home (PCMH) initiative to include nearly 1,050 primary care doctors in more than 100 physician practices that cover about 171,000 Highmark members in Western and Central Pennsylvania and West Virginia.
Click here for the story.

50-State Survey Shows Significant Medicaid Progress

States are moving closer to the Affordable Care Act’s goal of transforming the Medicaid enrollment process into a real-time, electronically based
experience, according to a 50-state Medicaid survey released last week. According to the report, the median coverage level for children stands at 235% of the federal poverty level. Coverage for parents is at a median eligibility level of 61% and adults without dependent children have few opportunities to access Medicaid. Click here for the survey.

Big Hospitals Hit Harder on Readmission Penalties: Study

Large, teaching, and safety-net hospitals are those most likely to be penalized for failing to reduce hospital readmissions, researchers found in a study out last week. In the federal Hospital Readmissions Reduction Program, 40% of large hospitals will likely see big cuts in their fiscal 2013 Medicare reimbursements compared with 28% of small hospitals. Click here for the report.

Community Coordination Reduces Readmits: Study

A new report out last week suggests that communities where hospitals, other health care providers, and community services work together to coordinate evidence-based hospital discharges and provide better support in the community, can see a 6% drop in hospitalizations and rehospitalizations, per 1,000 beneficiaries, in just the first two years. Click here for more.

Final HIPAA Regs Expand Protections; New Summary Available

The most sweeping regulatory changes to HIPAA have also been finalized  by HHS. New civil monetary penalties for differing degrees of violations, modifications to the sharing of genetic information and new individual protections are included. Fortunately, the several hundreds of pages of final regs have been expertly summarized by our policy team. You can read the 4-page summary here.

Top GOP Senator Announces Health Reform Plan

The top Republican on the Senate Finance Committee last week unveiled his own health care reform proposal. Sen. Orrin Hatch (R-UT) outlined five major changes including raising the Medicare eligibility age, modernizing medigap policies and Medicare competitive bidding for Medicare Advantage. Click here for the complete proposal.

Undocumented and Incarcerated Persons Getting Medicare Services: OIG

Illegal immigrants and prison inmates received more than $120 million in Medicare services from 2009-2011 despite federal law that makes them ineligible for the program, according to two new reports from the HHS inspector general out last week. Click here for the 17-page OIG report on illegal immigrants. Click here for the 22-page report on prison care.

Newborn Blood Infections Drop in AHRQ Program

Central line associated bloodstream infections in newborns were reduced by 58% in less than a year in hospital neonatal intensive care units participating in an Agency for Healthcare Research and Quality patient safety program, according to an announcement last week. Frontline caregivers in 100 NICUs in nine states relied on the program’s prevention practice checklists and better communication to prevent an estimated 131 infections and up to 41 deaths and to avoid more than $2 million in health care costs. Click here for a summary. Click here for the 32-page report.

Vermont Closer to Single Payer System

Vermont is moving closer to implementing its plan for a single-payer system in 2017. In a report out last week, the state said the plan will cost about
$3.5 billion, with the state picking up about $1.6 billion of the cost. Overall, the state predicts the single-payer system will save $281 million over the first three years. Click here for the informative 156-page state report.

Exchanges Will Increase Use of Refundable Tax Credits: CBO

The government will spend less on refundable credits this fiscal year, according to a new CBO report, but the drop will be only temporary because of new subsidies created by the 2010 health care overhaul. The government will spend only $149 billion on the credits in 2013 — down from a high of $238 billion in 2008. But that figure will increase to $213 billion by 2021 because of a new refundable tax credit available to some people for the purchase of health insurance through newly created exchanges. Click here
to see the CBO report.

Flu Hospitalizations, Deaths Increase

The CDC said Friday that flu activity appears to have leveled off in much of  the country, but that hospitalizations and deaths continued to climb with  the greatest impact on those over 65. Eight pediatric deaths were reported, compared with nine the week before, bringing the total number of  such deaths this year to 37. That compares to 34 for the entire 2011-2012 season, which was a very mild year. Click here to see more on this from the CDC.

CDC Says New Viruses Spreading Across US

If the flu wasn’t enough, a new norovirus strain, first detected in Australia last March, is spreading across the U.S., causing 141 of the 266 norovirus
outbreaks reported from September through December, CDC officials said last week. They also reported a rise in outbreaks of sickness caused by the consumption of raw milk. Click here for more in the USA Today.

Telemedicine Growth Continues: Report

An estimated 1.8 million patients will be treated through telehealth worldwide by 2017, according to report out last week from InMedica. They estimated that in 2012, 308,000 patients were remotely monitored for congestive heart failure, chronic obstructive pulmonary disease, diabetes,
hypertension and mental health conditions. Click here for further details.

Implantable Device Market Booming

A report out last week shows that the U.S. implantable medical devices market will grow at an annual compounded rate of 8% over seven years to be worth $73.9 billion by 2018. The market was valued at $43.1 billion in 2011 by Transparency Market Research, which published the report. Click
here for the story.

Allergan Looking to Expand Migraine Business

Allergan has agreed to pay nearly $1 billion to acquire MAP Pharmaceuticals and gain full control of its experimental treatment for migraine headaches, the two companies announced last week. Click here for the story.