CMS Orders Some States To Pause Medicaid Redeterminations

Modern Healthcare: Medicaid Unwinding Paused In Some States As CMS Finds Violations 
CMS has already ordered several states to pause redeterminations to address their failure to adhere to federal standards and is working with about a half dozen states to correct ongoing violations, Tsai said. The agency has required some states to pause so-called procedural terminations not related to eligibility and to reinstate coverage for those affected by policy, operational or compliance violations, he said. CMS is monitoring an additional dozen states to determine if they are in violation of Medicaid regulations. One state failed to provide some enrollees with renewal forms, and another didn’t implement required auto-renewal mitigation strategies, according to a CMS fact sheet. The agency continues to monitor states, intervene when necessary and offer technical assistance. (Berryman, 7/19)

Politico: CMS Not Ready To Penalize States With Poor Medicaid Redetermination Records
The Biden administration knows thousands of Americans eligible for Medicaid are losing their health insurance because of paperwork problems — but CMS said Wednesday it isn’t ready to penalize states where it is happening. Instead, CMS leaders told reporters Wednesday they are working with several states in which a large number of eligible recipients have seen their coverage terminated. (King, 7/19)

• KFF's Medicaid Enrollment And Unwinding Tracker (Updated 7/19)

Forbes: Pandemic-Era Medicaid Enrollees Shifting To Obamacare In A Big Way
One of the nation’s largest health insurance companies is seeing a big boost in individual enrollment under the Affordable Care Act in part from consumers who had been covered by Medicaid during the Covid-19 pandemic. Elevance Health, which operates Blue Cross and Blue Shield plans in 14 states, is seeing thousands of Americans formerly covered by Medicaid shift to individual coverage on the ACA’s exchanges as states unwind the “continuous coverage requirement” implemented at the beginning of the pandemic to ensure people retained health benefits. (Japsen, 7/19)

On next year's ACA premiums —

Axios: Higher Health Costs Set The Stage For ACA Premium Hikes For 2024
Inflation may be cooling, but high medical costs could still make consumers pay more for Affordable Care Act health insurance in 2024. Why it matters: President Biden has launched an offensive focused on lowering consumers' medical costs. Higher premiums for ACA marketplace plans could throw a wrench in the administration's messaging as Biden's re-election campaign takes off. (Goldman, 7/20)

And on Medicare —

MarketWatch: Medicare Advantage Could Get Up To $1.6 Trillion More Than It’s Entitled To
Medicare Advantage plans could end up getting too much money from the government — by as much as $1.6 trillion — over the next decade, putting pressure on the trust fund that supports Medicare. This forecast comes from the Committee for a Responsible Federal Budget, which looked at the intricacies of insurance coding, as well as the demographics of who signs up for different types of Medicare plans. Medicare Advantage is the private-plan alternative to traditional Medicare. (Hall, 7/19)

Business Insider: Bill Proposed To Let Medicare Cover Weight-Loss Drugs Like Wegovy
A major roadblock has long stood in the way of older Americans getting treatments for obesity: Medicare. The federal program that provides health coverage for people 65 and older is prohibited by a 2003 law from paying for weight-loss drugs such as Wegovy — the expensive injection that's taken the world by storm. And without insurance, most people can't afford the shots, which can cost upwards of $1,000 a month. (Livingston, 7/20)

Bloomberg Law: Medicare Bids To Fill Mental Health Coverage Gap After Hill Push
Credit Congress for Medicare’s recent move to fill a gaping hole in its behavioral health coverage next year.Section 4124 of the Consolidated Appropriations Act of 2023 required Medicare to start covering “intensive outpatient” mental health and substance use disorder services in 2024. The coverage—which entails nine to 19 hours of treatment services per week—is part of a “continuum of care” developed by the American Society of Addiction Medicine. (Pugh, 7/20)

AP: Jill Biden Welcomes Proposal For Medicare To Pay For Navigation Services For Cancer Patients
First lady Jill Biden on Wednesday welcomed a new proposal to have Medicare pay for navigation services for cancer patients, saying it will make “an enormous difference in people’s lives.” She joined other Biden administration officials on a conference call to discuss a proposal by the Centers for Medicare and Medicaid Services to pay for “principal illness navigation services,” which help patients make decisions about treatment for cancer and other serious illnesses and overcome barriers to quality care. (Superville, 7/19)

In other Biden administration news —

Modern Healthcare: FTC, DOJ Merger Proposal Could Impact Healthcare Consolidation
The Justice Department and the Federal Trade Commission on Wednesday released draft merger guidelines designed to crack down on deals that constrain labor markets and those that allow organizations to control services that rivals may use to compete, among other types of transactions. The draft includes more than a dozen guidelines that would impact merger oversight across all sectors of the economy, including healthcare. (Kacik, 7/19)

Axios: FDA Weighs When Software Becomes A Medical Device
An effort to get the FDA to pull a widely used prescription drug monitoring software package off the market is stoking a broader debate over how much technology is influencing opioid prescribing. Driving the news: The Center for U.S. Policy says Bamboo Health's NarxCare should be classified a medical device and subject to regulation, because of the way it helps doctors and other providers decide if a patient should get painkillers. (González and Moreno, 7/19)

On newsworthy resignations —

The Hill: Top DEA Official Resigns After Report On Consulting Work
A top U.S. Drug Enforcement Administration official has resigned from his office after reporting from the Associated Press on his previous work for the pharmaceutical industry. Louis Milione, the former principal deputy administrator for the DEA, previously worked for four years as a consultant to large pharmaceutical companies including Perdue Pharma, according to the AP’s reporting. (Suter, 7/19)

The New York Times: Stanford President Resigns After Report Finds Flaws In His Research
Following months of intense scrutiny of his scientific work, Marc Tessier-Lavigne announced Wednesday that he would resign as president of Stanford University after an independent review of his research found significant flaws in studies he supervised going back decades. The review, conducted by an outside panel of scientists, refuted the most serious claim involving Dr. Tessier-Lavigne’s work — that an important 2009 Alzheimer’s study was the subject of an investigation that found falsified data and that Dr. Tessier-Lavigne had covered it up. (Saul, 7/19)