Weekly Medicaid RoundUp: Week of November 20th, 2017

Clay’s Weekly Medicaid RoundUp: Week of November 20th, 2017

Soundtrack for today’s RoundUp pessimist readers-  No room for pessimists this week. Be thankful you pessimists!


For optimist readers- https://www.youtube.com/watch?v=uYJ-MXwbQlY


 TOP 10 THINGS I AM THANKFUL FOR ON THANKSGIVING 2017- 1) A God that loves me; 2) A family that loves me; 3) Being born in the most awesomest country in the world, warts and all; 4) Clients that have vision to improve a critical but deeply flawed Medicaid program; 5) Gardening; 6) Music; 7) One more Thanksgiving with my Dad before he is no longer with us due to brain cancer; 8) Asking “what’s public health?” decades ago while finishing up a history degree and never looking back; 9) Friendships that I have had for more years than I have not; 10) Making new friends at conferences each year. Speaking of…


LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1


THIS ONE IS A SHORT ONE THIS WEEK DEAR, DEAR READERS- It’s 4:30 AM the day after Thanksgiving and apparently that means to go buy stuff at Kohl’s. So my wife is out doing that – and soon I will have the sound of little feet turning to a stampede in my house as the cousin-children all wake up with excitement to see each other. And I will not be able to pontificate on all things Medicaid my normal duration (measured in cups of coffee; normal time – 2 cups to write it, 1 to proof it). Here are the quick hits of what happened in our world this Thanksgiving week:


MA PROPOSES NOVEL RX IDEA: DON’T SPEND MEDICAID DOLLARS ON SNAKE OIL, FEND FOR YOUR OWN DISCOUNTS- Most Medicaid drug coverage policy is summarized as “if the FDA approves it, we pay top dollar for it.” So if Hadacol were still around, states would be begging to buy it. (The things I have seen in state RX data would make your stomach turn – don’t get me started on $10k nail fungus drugs). So- Massachusetts, driven by a lack of options to deal with the crushing weight of specialty drugs costs, is going rogue. Or asking permission to go rogue if you want to get technical. They are submitting a waiver request to be able to non-cover drugs with limited effectiveness AND to negotiate their own darn discounts, thank-you-very-much fancy national MDRP program. In a time of stalemate on Rx costs and ideas to deal with them, we wish you luck Massachusetts.


IOWA CAID GROANS IN FRUSTRATION- One of the results of an MCO skipping town (see previous reporting on Amerihealth’s departure, and by skipping town I do not mean to imply they did it lightly. Read up on it before passing judgment) is that there is less member choice in terms of plans come enrollment time. Which is starting to bubble up in the local news with stories of members who are being turned away by non-network providers, and then being told by the state they can’t switch plans. Adding to the pressure of Amerihealth’s departure is the fact that Amerigroup is no longer taking new members. Finally- the Federalis are not yet rubberstamping Iowa’s request to roll the state back to Fee For Service and do away with managed care altogether.


GOOD GUVN’R BEL EDWARDS SAYS ALL ANIMALS ARE EQUAL, BUT SOME ANIMALS ARE MORE EQUAL THAN OTHERS (WHEN IT COMES TO GOVERNING USING CHECKS AND BALANCES THAT IS)- The Good Guvn’r says he “had no choice” but to ignore the also-duly-elected-by-the-people Louisiana legislature when the reps wanted to be a part of the MCO contract renewals decision last month. Bel Edwards (like many Governors) has realized there actually is a heck of a lot he can do without approval of the legislature, and recently rammed through “emergency contracts” to keep MCOs going past the current termination date (November). Why did it ever get to this point in the first place? What type of contracting process allows this outcome? Anyone in The Pelican State that knows more on LA procurement practices, please write in and let me know.


WELCOME TO THE SHOW MR RANDOL- Joining the rare but growing ranks of the 2-timers, former Kansas Medicaid Director Michael Randol will now sit in the chair of Iowa Medicaid. Congratulations Michael!


TELEMEDICINE CATCHES THE EYE OF OIG- OIG has scheduled a review of the appropriateness of Medicaid payments for telemedicine for 2019. The Federalis expect Medicaid telemedicine spending to grow significantly in the next few years, and OIG wants to check in on how compliant recent spending has been with the regs before the ramp up happens.


That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (work off that 4th serving of dressing) and keep running the race (you know who you are).

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