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Archive for February 2018

States Adopt New Tools to Control Rising Medicaid Drug Costs

Faced with continued increases in the cost of prescription drugs in their Medicaid programs, states are pursuing new approaches in attempts to control those rising costs. In the past states have employed approaches such as beneficiary prescription limits, negotiating supplemental rebates from manufacturers, requiring prior authorization, implementing state maximum allowable cost programs, and operating preferred drug lists. Recently, however, states are turning to a number of new mechanisms to limit the growth of Medicaid prescription drug costs, including: introducing spending growth caps for Medicaid prescription drug costs, with unplanned increases in spending triggering a closer look at overall drug spending and a focus on specific drugs for utilization review; closed formularies; doing more to promote the use of generic drugs; … Read More

Posted in Uncategorized

Community Health Center Patients Often Have Housing Problems

Nearly half of the patients served by community health centers have housing problems, according to a new report published by the Journal of the American Medical Association. Among those problems:  two or more homes in the past year alone, difficulty paying their rent or mortgage, and homelessness.  Some have homes that are not their own. Practitioners need to understand this and help patients address their housing challenges, the study suggests, because housing concerns often prevent such patients from complying with medical instructions. Learn more about how housing challenges affect health and health care in the JAMA report “Prevalence of Housing Problems Among Community Health Center Patients,” which can be found Nearly half of the patients served by community health centers … Read More

Posted in Pennsylvania safety-net hospitals

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a specified period of time Medicaid recipients who have not gone through annual eligibility redetermination or have failed to pay Medicaid … Read More

Posted in Federal Medicaid issues

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has just published the latest edition of its Health Law News newsletter. Included in this edition are articles about the elimination of Medicaid restrictions on prescription drugs for hepatitis C, the launch of the Community HealthChoices program of managed long-term services and supports in the southwestern part of the state, and more. Find these stories and others here, in the latest edition of Health Law News.  

Posted in Pennsylvania Medicaid, Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy

340B on the Move?

Consider moving the section 340B prescription drug discount program from the Health Resources and Services Administration to the Centers for Medicare & Medicaid Services. That was the message in a recent letter from Senate Finance Committee chairman Orrin Hatch to new Secretary of Health and Human Services Alex Azar. In his letter, Senate Hatch observes that HRSA lacks the necessary regulatory authority to oversee the 340B program. The agency only has the authority to regulate in three areas, which include establishing an alternative dispute resolution process, imposing civil monetary penalties against manufacturers who knowingly overcharge covered entities, and calculating the 340B ceiling price. Even so, it has not fully implemented these regulations. HRSA audits covered entities for program eligibility, duplicate … Read More

Posted in Medicare

NQF to Medicaid: Do a Better Job of Addressing Social Determinants of Health

State Medicaid programs need to do a better job of measuring and addressing the social risks their patients face, the National Quality Forum has asserted in a new report. To do so, NQF concluded, state Medicaid programs should “…work more with healthcare organizations and communities to better manage social disparities.” How? According to the NQF, state Medicaid programs should: Acknowledge that Medicaid has a role in addressing social needs that impact health. Create a comprehensive, accessible, routinely updated list of local community resources for healthcare organizations. Harmonize tools that assess social needs that impact health to ensure that they collect and document the same type of information. Create standards for inputting and extracting social needs data from electronic health records … Read More

Posted in Uncategorized
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