This week, the Centers for Medicare & Medicaid Services demonstrated it doesn’t automatically approve every Medicaid waiver requested by a conservative state. CMS denied a waiver to impose lifetime limits on Medicaid benefits, saying they need to be available to people when they need them. Kansas had proposed a three-year limit, after which people would lose access to Medicaid for life. Arizona, Utah and Wisconsin have asked for similar limits. The administration previously approved big changes through state-based waivers to allow work requirements for able-bodied Medicaid recipients, but CMS administrator Seema Verma says there’s a distinction between that and lifetime limits.
(
The Hill
;
Politico
)
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It’s the season for health insurers to submit requests for premium hikes for plans on the Affordable Care Act marketplaces, and the early news is mixed for consumers. In Virginia, CareFirst is proposing a 64 percent average increase, while Cigna asked for a 15 percent average increase. Cigna says it expects sicker people in the independent market next year because Congress repealed the individual mandate and healthy people are likely to opt out of marketplace coverage altogether. In the same state, Optima is seeking an average 1.9 percent decrease in premium costs. Rate hikes are universal but highly variable in Maryland, ranging from 18.5 percent to 91.4 percent.
(
FierceHealthcare
;
The Hill
;
Baltimore Sun
)
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Innovation & Transformation
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The National Institutes of Health officially kicked off its genetic research program, All of Us, with public events May 6 in New York; Birmingham, Ala.; Nashville, Tenn.; Detroit, Mi.; Kansas City, Mo.; Chicago; and Pasco, Wash. The program’s goal is to collect genetic data from a million people representing a variety of ethnicities and health profiles. All of Us will create a genetic database that can be tapped by researchers to accelerate development of personalized medicine. Speakers emphasized data security as a top priority for the initiative. More than 25,000 participants provided genetic data during the test phase. (
Bio IT World
;
Chicago Sun-Times
)
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Geisinger Health System, which has overseen the DNA sequencing of 93,000 patients since 2014 (and alerted more than 500 patients whose results put them at risk for developing early cancers or heart problems), will pilot a program recommending DNA sequencing as part of routine clinical care—like mammograms, colonoscopy and cholesterol checks—for patients across Pennsylvania and New Jersey. The idea is to proactively plan for health management using genetic data. The pilot will enroll 1,000 patients; if a genomic risk factor is identified, physicians will work with patients to respond. (
Modern Healthcare
)
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Minnesota’s Medicaid program is paying for some 1,500 people under age 65 to live in nursing homes because it can’t find enough personal care aides to help people with disabilities live at home. Some advocates say confining them to nursing homes is a civil rights issue in conflict with the Olmstead Act, and 2016 Justice Department action against South Dakota for similar institutionalization was deemed illegal. Others note that nursing home care is much more costly than receiving care in the community. Most of the patients just want to go back home.
(
Minnesota Star Tribune
)
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About half the cuts President Trump is seeking from Congress in a new rescission bill relate to the Children’s Health Insurance Program and the Center for Medicare & Medicaid Innovation program to test alternative payment models. The cuts are for funding that was budgeted years ago and remain unused, but $2 million of the CHIP money is for a contingency fund. Congress has 45 days to address the request. The administration has voiced displeasure with Congress’s $1.3 trillion budget bill, but none of the rescission requests pertain to that funding. (
Vox
;
Newsweek
)
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DEA suspends opioid wholesaler:
Delivering six times a drugstore’s normal order for opioids without first notifying the DEA isn’t the smartest thing to do when the administration is on high alert for shenanigans. Drug wholesaler Morris & Dickson of Shreveport, La., says it will show the DEA “got it wrong” and plans to fight its suspension.
(
The Washington Post
[subscription required])
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Athenahealth targeted for takeover:
New York hedge fund Elliott Management is maneuvering to take over the cloud-based EHR vendor, which has struggled financially to scale profitably. Elliott is offering to pay $160 cash per share; it already owns 9.2 percent of the company’s stock. Athenahealth's CEO is said to be considering the unsolicited proposal. (
HealthcareITNews
)
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Massachusetts merger in the horizon
: Boston-based Partners HealthCare and health plan Harvard Pilgrim Health Care are in merger discussions. Partners owns a dozen hospitals, including Massachusetts General and Brigham and Women’s, plus thousands of physician practices. Any deal will have to pass muster with the state’s Health Policy Commission and attorney general’s office. (
Boston Globe
)
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PCMA shakeup at the top:
The Pharmaceutical Care Management Association announced CEO and President Mark Merritt will step down at the end of this year. Insiders say the trade organization’s PBM members are frustrated that the organization failed to put a better face on the industry’s role in setting prescription drug prices. Merritt has led PCMA since 2003. (
Axios
)
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Introducing Health2 Resources' Baffled Health™ Podcasts
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Baffled Health™ is Health2 Resources’ podcast series about real people, totally bewildered, on their health care journey. On this five-minute podcast, we accompany Ryan on his Baffled Health journey to pay for daily care across three states, navigating labyrinthine rules to get the services he needs as a college professor with a physical disability. Find out why. (
Baffled Health podcast
)
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MarketVoices...quotes worth reading
“It’s difficult to find quality staff when they can make the same pay flipping burgers at McDonald’s and do a lot less work.” Nursing home patient Carla Friese, 54, of Hopkins, Minn., as quoted by the
Minnesota Star Tribune
.
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Sandy Mau
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