CMS Issues Rule to Promote Drug Price Transparency by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development

This week, the Centers for Medicare & Medicaid Services (CMS) unveiled a much anticipated  proposed rule aimed at increasing drug price transparency and reducing the price of prescription drugs. The rule would require drug manufacturers to include list prices in all direct-to-consumer television advertisements of prescription drugs and biological products for which Medicare or Medicaid reimbursement is available. The specific drugs that would require list price disclosure are those that are used for a 30-day regimen or for a typical course of treatment and for which the list price is greater than $35 per month.
 
AzHHA believes the escalating price of prescription drugs threatens the affordability of healthcare for all Arizonans, and we strongly support policy recommendations proposed by the Campaign for Sustainable Rx Pricing. The proposed rule by CMS is certainly a step in the right direction. Comments on the proposal will be accepted through December 17th. For more information, see the agency’s press release.

Medicare Advantage Plans Denying Medical Services to Maximize Profits by Joe Furia

Ann-Marie Alameddin, Vice President of Strategy and General Counsel

A recent Department of Health and Human Services Office of Inspector General (HHS OIG)  report indicates Medicare Advantage plans could be denying medical services to maximize profits. According to the report, when beneficiaries and providers appealed preauthorization and payment denials, Medicare Advantage organizations overturned 75 percent of their own denials between 2014 and 2016. "The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided," said the HHS OIG in the report. "MAOs may have an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits." The report recommends that CMS enhance its oversight of Medicare Advantage plans and address persistent problems related to inappropriate denials and insufficient denial letters.

GAO Report on Medicaid Expansion by Joe Furia

Debbie Johnston, Senior Vice President of Policy Development

Low-income adults in states that expanded Medicaid under the Affordable Care Act were less likely to report having any unmet medical needs compared with those in non-Medicaid expansion states, according to a Government Accountability Office report released last week. The report, which analyzed data from the 2016 National Health Interview Survey, found:

  • About 26 percent of low-income adults in Medicaid expansion states reported having unmet medical needs compared to 40 percent in non-expansion states.

  • About 9.4 percent of low-income people in Medicaid expansion states said that they passed up needed medical care in the past 12 months because they couldn't afford it, compared to 20 percent in non-expansion states.

  • About 82 percent of low-income adults had a usual place of care in Medicaid expansion states compared to 68 percent in non-expansion states.

Access to medically necessary care is the primary reason AzHHA was a strong supporter of then-Governor Jan Brewer’s 2013 initiative to restore Arizona’s Prop. 204 program, and it’s why we continue to support the program five years later.

HFMA HERe Conference by Joe Furia

Jim Haynes, Senior Vice President and Chief Operating Officer

In today’s social environment, the importance of mental health and wellness cannot be overstated. The 2018 Women Lead HERe Conference will provide attendees with the inspiration and actionable tools needed to create and sustain mental wellness in the workplace, at home, and within yourself. Join the growing community of HERe Women Leaders on November 2nd at The Clayton House for a day of education, inspiration, and connection. Be a part of this impactful, fun event by registering today. Space is limited.

AzHHA Offering Community and Professional Trainings in November by Joe Furia

Karen Beckford, Program Director of Thoughtful Life Conversations

Education is crucial to developing the skills necessary to having quality conversations about advance care planning and AzPOLST (Arizona Physician’s Orders for Life Sustaining Treatment). AzHHA’s Thoughtful Life Conversations (TLC) program is bringing training to communities across Arizona. These trainings provide individuals and healthcare professionals with the skills necessary to have quality conversations about advance care planning and to build a diverse understanding of palliative and end-of-life care. New dates and locations have been added. Join Thoughtful Life Conversations for these exciting opportunities to expand your knowledge and expertise. Click here to view the community education dates and here to view the healthcare professional dates. Don’t see a scheduled training near you? Contact Karen Beckford to bring these trainings to your community.

Point of Pride: Encompass Health Valley of the Sun Rehabilitation Hospital by Joe Furia

Earlier this month, Encompass Health Valley of the Sun Rehabilitation Hospital was recognized with the Outstanding Performance in Patient Satisfaction Award and the Outstanding Performance in Employee Engagement Award during Encompass Health’s Annual Meeting and Awards Banquet held October 5th  in Orlando, Florida. Encompass Health Valley of the Sun is one of only eight hospitals in Encompass Health’s nationwide network of 130 inpatient rehabilitation hospitals to receive the Outstanding Performance in Patient Satisfaction Award. This distinction recognizes the hospital’s high patient satisfaction scores from the past year. Congratulations to our member for earning such distinction and for their continuous efforts in providing excellent patient care.