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June 25, 2024

Security Group Rates Healthcare Cyber Readiness

SecurityScorecard gave healthcare a “B+” in cybersecurity, but some healthcare organizations had low ratings despite the group concluding that ratings were “higher than expected.” I tend to think that ratings are a bit inflated, but nonetheless it is a good service for the nation.

#cyberattacks #healthcare

https://www.fiercehealthcare.com/health-tech/report-90-healthcare-orgs-get-b-cybersecurity-medical-devices-fall-below-mark

Bipartisan Group Of Lawmakers Wants Greater MA Restrictions On AI Use

A bipartisan group of senators and representatives are back at it, touting the agenda of provider lobbies.  The group sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking the agency to rein in the use of AI in prior authorizations and to potentially suspend the use of internal criteria until such time CMS rules can be written.

Additional articles: https://www.modernhealthcare.com/politics-policy/medicare-advantage-ai-restrictions-prior-authorization and https://insidehealthpolicy.com/daily-news/congress-cms-step-oversight-ai-algorithms-ma-prior-authorization and https://www.beckerspayer.com/policy-updates/tougher-rules-needed-for-medicare-advantage-ai-51-lawmakers-say.html and https://thehill.com/policy/healthcare/4739152-bipartisan-lawmakers-increased-ai-oversight-medicare-advantage-coverage/

(Some articles may require a subscription.)

#ai #medicareadvantage #priorauthorization

https://www.statnews.com/2024/06/25/medicare-advantage-ai-tools-denial-unitedhealth-lawmawkers-cms/

Analysis Of ACA Preventive Services Lawsuit

A good article recapping the recent decision on the Affordable Care Act’s (ACA) zero-cost preventive services.  While the services remain in place for now, an appellate remanded the case back to the district court to review.  At question is the power of certain bodies to recommend coverage decisions when they are not presidentially appointed and confirmed by the Senate. At least one body, the preventive services task force, was clearly ruled problematic.

(Article may require a subscription.)

#aca #obamacare #prevention

https://www.modernhealthcare.com/policy/braidwood-decision-aca-preventive-care-coverage-prep-vaccines

CMS To Recommend PrEP In Medicare

The Centers for Medicare and Medicaid Services (CMS) will recommend a national coverage determination (NCD) for preexposure prophylaxis (PrEP) using antiretroviral drugs to prevent HIV. The NCD will cover the drugs for prevention under Part B, as opposed to the same drugs for treatment under Part D.

(Article may require a subscription.)

#cms #ncd #lcd #medicareadvantage #partd #pdp #hivaids

https://insidehealthpolicy.com/inside-drug-pricing-daily-news/cms-pharmacies-prepare-prep-coverage-determination-late-september

PhRMA And Milliman Analysis Claim Higher Costs Will Result For Medicare Enrollees

I had great respect for the actuarial firm Milliman, but it really should be ashamed of itself for agreeing to perform an analysis backed by the brand drug maker lobby PhRMA concluding that 3.5 million Medicare enrollees will see higher out-of-pocket costs in 2026 due to drug price negotiations.  The analysis suggests that formulary placement will require these enrollees to pay copays instead of coinsurance and that they won’t fully benefit from the new out-of-pocket limit in Part D.

The actuarial firm and drug lobby use terribly twisted logic.  The Inflation Reduction Act (IRA) was an overall package of reforms to lower system and individual costs. There is no question that the overall package reduces drug prices for the healthcare system and individuals.  More ridiculous arguments from brand PhRMA, which seeks to turn any attention away from its high prices, ridiculous margins, and the vast disparity between U.S. prices and others in the developed world.  Again, how could Milliman sign on to something as misleading as this. Statistics don’t lie, but liars use statistics.

(Article may require a subscription.)

#drugpricing #ira #branddrugmakers

https://insidehealthpolicy.com/daily-news/phrma-backed-report-finds-ira-will-lead-12-cost-increase-part-d-enrollees

Hybrid Life-LTC Insurance Could Have Possibilities

I have long argued that America needs an aging policy, both with increased government coverage of long-term care, sliding-scale buy-ins, and reform of the long-term care insurance market.  The article does a good job of discussing the issues at hand.  I liked the discussion of hybrid coverage for life and long-term care.

#aging #ltc #longtermcare #medicaid #healthcare

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/110819

— Marc S. Ryan

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