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Price expected to address questions about marketplace
Hill Republicans and outside experts believe HHS Secretary Tom Price will make stabilization of the individual marketplace a top priority, at least in the short term. The Trump administration has not yet indicated what parts of the ACA they plan to continue enforcing while Congress builds a replacement, which has contributed to uncertainty in the marketplace. Many insurers have indicated they need more details before they can commit to participating in the marketplace for the 2018 coverage year, writes Mary Ellen McIntire of Morning Consult. Price’s focus on stabilization would build on existing efforts to stabilize the market, which include the administration’s revision of rules governing enrollment, as reported by Robert Pear of The New York Times.
Kasich defends Medicaid expansion in criticism of House ACA replacement
Governor John Kasich (R-OH) opposes a plan for replacing the ACA outlined by congressional Republicans late last week. Kasich believes provisions in the bill that phase out Medicaid would lead to cuts in coverage and leave disadvantaged Americans vulnerable, reports Peter Sullivan of The Hill. Disagreements about how to handle the Medicaid expansion rolled out under the ACA are a major sticking point in Republican efforts to repeal and replace the ACA.
Justice Department accuses UnitedHealth of manipulating risk scores
The Justice Department has filed a lawsuit against UnitedHealth Group, alleging the insurer defrauded the government by filing false and inflated Medicare charges. UnitedHealth Group is accused of fudging risk scores in order to recoup higher fees under Medicare’s risk adjustment rules. UnitedHealth denies the accusations and asserts the Justice Department is misinterpreting Medicare rules. Bob Herman of Axios notes analysts believe Medicare Advantage may face higher scrutiny as a result of the lawsuit.
Insures dropping prior authorization
Aetna joined Anthem and Cigna in no longer requiring prior authorization for medications to treat opioid addiction. According to addiction specialists, in the brief window of time it takes doctors to receive approval from insurers, patients can change their minds about treatment or go into withdrawal, putting their health at risk. Anthem and Cigna took the step after facing investigation with New York’s attorney general, whose office was probing whether their coverage practices unfairly barred patients from needed treatment. Shefali Luthra at Kaiser Health News has the story.
CMS helps small practices implement MACRA
Eleven community-based health organizations will receive around $20 million from the Centers for Medicare and Medicaid Services (CMS) to help small practices make the shift toward the Quality Payment Program under MACRA. The organizations will use the funds to assist small clinician practices or individual providers by providing technical assistance, including optimizing technology and strategic planning. CMS plans to spend about $80 million more during the five-year program to provide assistance to clinicians, explains Elizabeth Whitman of Modern Healthcare.
Maine requests soda ban for food stamp program
The Maine Department of Health and Human Services (DHHS), which administers the federal food stamp program for the state, has asked the U.S. Department of Agriculture to no longer include candy, soft drinks and soda in the Supplemental Nutrition Assistance Program (SNAP). Each year in Maine, about $13 million in food stamp spending goes toward soft drinks, according to DHHS. Maine needs a waiver to change the items covered in SNAP since it is a federal program. David Charns at WMTW News 8 in Portland, Maine shares that similar waivers have been denied by the USDA.