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CMS launches payment model for state Medicaid programs to purchase drugs at most-favored-nation pricing

The Centers for Medicare & Medicaid Services is launching a new initiative for state Medicaid programs to purchase prescription drugs at prices aligned with those paid in other countries, known as most-favored-nation pricing.
Current & Emerging Payment Models, Medicaid
Member

AHA Nov. 5 Letter to CMS on Medicaid State-directed Payments (SDPs)

AHA Nov. 5 sent a letter to the Centers for Medicare & Medicaid Services with recommendations for implementing specific provisions in the OBBBA.
Medicaid, Advocacy & Public Policy, Legislation and Legislative Advocacy

White House announces deals with Eli Lilly, Novo Nordisk to lower drug costs 

The White House announced today that it reached agreements with Eli Lilly and Novo Nordisk to align their drug prices with the lowest paid by other developed nations, known as the most-favored-nation price.
Drug Prices, Medicaid

Improving Maternal Outcomes Starts with Knowing Why

According to the CDC, 80% of pregnancy-related deaths can be prevented; that’s a 20% increase from previous years. Know why? That’s the theme for today’s Maternal Health Awareness Day – Know Why. Maternal Health Awareness Day, Jan. 23, shines a light on the many complex factors contributing to maternal health deaths and amplifies promising initiatives to combat the rising rates of maternal morbidity and mortality.
Maternal Health, Medicaid, Clinical Integration, Access to Behavioral Health, Reducing Healthcare Disparities

HHS authorizes five states to provide health care coverage for people transitioning out of incarceration 

The Department of Health and Human Services July 2 announced it will provide Medicaid and Children's Health Insurance Program coverage to incarcerated people in Illinois, Kentucky, Oregon, Utah and Vermont prior to release.
Medicaid, CHIP, Reducing Healthcare Disparities

OIG says MA, Medicaid managed care plans have limited, inaccurate behavioral health provider networks 

A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans offer access to a limited proportion of behavioral health providers, and inaccurately list 72% of in-network behavioral health care providers as being available.
Medicare Advantage, Medicaid, Access to Behavioral Health
Member

UPDATED: Implications for Hospitals and Health Systems During a Government Shutdown

Over the past 15 days, the Senate has voted nine times on the House-passed continuing resolution (CR) to extend government funding and health care waivers until Nov. 21.
Legislation and Legislative Advocacy, Advocacy Alliances, Medicaid DSH, Telehealth, Rural issues
Member

UPDATED: Implications for Hospitals and Health Systems During a Government Shutdown

Government funding and certain health care programs and waivers expired at midnight Sept. 30 as congressional leaders were unable to reach an agreement to keep the government funded.
Legislation and Legislative Advocacy, Advocacy & Public Policy, Medicaid DSH, Telehealth, Rural issues

Study finds Medicaid beneficiaries most likely to lose coverage due to work requirements have worse health  

A JAMA study published yesterday analyzed the health characteristics of individuals projected to lose Medicaid coverage due to work requirements included in the budget reconciliation bill (H.R. 1).
Medicaid, Heart Disease, Cancer, Diabetes, and Other Chronic Diseases

CMS releases updated guidance to states on federal financing for emergency Medicaid services 

The Centers for Medicare & Medicaid Services Sept. 30 released guidance to states clarifying its interpretation of a provision that authorizes federal financing to pay for emergency Medicaid services for undocumented patients ineligible for full Medicaid benefits.
Medicaid