May 10, 2024

DOJ Sets Up Antitrust Task Force

The U.S. Department of Justice (DOJ) has set up a multi-disciplinary task force to examine healthcare monopolies and collusion. It will facilitate policy advocacy, investigations, and civil and criminal enforcement.

#antitrust #mergers #acquisitions #manda


New Spending Regulation Could Force Consolidation In Home Care

The new home care 80-20 requirement, which directs 80% of all Medicaid revenue to wages, could have an unseemly outcome.  Small mom-and-pop shops may have to sell off to private equity firms and large home care companies due to the onerous nature of the regulation.

(Article may require a subscription.)

#nursinghomes #homecare #medicaid


Biden Administration To Propose Cybersecurity Standards

The Biden administration will require hospitals to meet minimum cybersecurity standards as an outcome of the Change Healthcare cyberattack.  Ascension, a large hospital chain, just suffered a cybersecurity incident that impacted multiple systems, including its electronic health records. In addition, ransomware group Black Basta is accelerating its attacks against the healthcare industry.

Additional articles: https://www.modernhealthcare.com/cybersecurity/ascension-outage-cyberattack-ehr-mychart and https://www.beckershospitalreview.com/cybersecurity/ransomware-group-intensifies-attacks-on-healthcare.html

(Some articles may require a subscription.)

#cyberattacks #healthcare #hospitals #healthplans


Medicaid Unwinding Redeterminations Extended

The Biden administration has extended for one year the unwinding process for Medicaid state agencies.  While most redeterminations have occurred, some volume remains.

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#medicaid #redeterminations


Medicare Drug Negotiation Rule Proposals Maintained

The Centers for Medicare and Medicaid Services (CMS) has maintained rather strict rules related to how it will pick the next round of Part D drugs for price negotiations. The rules are strict but fair and will stop gaming by brand drug makers. You certainly cannot question the approach: the administration has won every battle in court so far against the brand drug makers!

(Article may require a subscription.)

#ira #drugpricing #branddrugmakers


Article Recounts Momentum Behind PA Reform In MA

Since a recent Health and Human Services’ Office of Inspector General (HHS OIG) report on prior authorization (PA) in Medicare Advantage (MA), reform proposals from the Centers for Medicare and Medicaid Services (CMS) and Capitol Hill have been notable, including interoperability and electronic PA requirements, a new PA limitation rule, and the resurrection of a bipartisan PA bill. More restrictions are coming. This is bad news for MA plans and, in the end, consumers.

(Article may require a subscription.)

#medicareadvantage #priorauthorization


Critical Report Says Florida Cut 600,000 Kids From Coverage

A report critical of how states are redetermining eligibility says 600,000 children were removed by the state of Florida from Medicaid and children’s insurance during the redetermination process in 2023.

#fl #medicaid #redeterminations


GLP-1 Weight-Loss Drug Coverage Expanding

A survey has new statistics showing the popularity of GLP-1 weight-loss drugs. A Kaiser Family Foundation (KFF) survey finds that 1 in 8 reported using GLP-1 drugs at some point and 6% said they are currently taking these drugs. About a quarter said their insurance covered the entire cost of the treatment. A majority of respondents, 57%, said insurance covered part of the cost. About 62% said they were taking the drugs for a chronic condition and not just weight loss.

KFF analysis:  https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/

Additional article: https://www.beckerspayer.com/payer/1-in-4-people-taking-weight-loss-drugs-say-insurance-covered-the-full-cost.html

#weightlossdrugs #drugpricing


Referendum Could Sink Washington State Long-Term Care Program

Washington State provides $36,500 in long-term care costs for residents in a public insurance program via a payroll tax. While controversial, a referendum could allow opt out from the program.  The move would mean further increasing taxes as people opt out.

#longtermcare #wa #ltc


— Marc S. Ryan

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