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What We're Reading: GAO Slams CMS; Walker Gets Friendly Toward ACA; Opioid Bills in House
A study by the Government Accountability Office (GAO) found that some states are slow to complete evaluation reports of Medicaid Section 1115 waivers; Wisconsin Gov. Scott Walker (R) is proposing a $200 million reinsurance program to cover high-cost patients; the House Energy and Commerce subcommittee will hold a hearing on bills containing enforcement-related measures aimed at the opioid crisis.
GAO Slams CMS on Slow Reporting of Section 1115 Results
A study by the Government Accountability Office (GAO) found that some states don’t complete evaluation reports of Medicaid Section 1115 waivers for up to 7 years after the demonstrations begin, thus failing to determine if the experiments are effective, Kaiser Health News reported. GAO also criticized CMS for failing to make the results publicly available quickly, “missing an opportunity to inform federal and state policy discussions,” according to the report. About one-third of Medicaid’s $300 billion annual spending goes to test programs.
Wisconsin Governor Proposes Reinsurance Plan, Other ACA Protections in Re-Election Year
Wisconsin Gov. Scott Walker (R) is proposing a $200 million reinsurance program to cover high-cost patients in that state. It’s a turnabout for Walker, who is against the Affordable Care Act (ACA), but he is up for re-election this year. His plan would include some ACA protections for people with pre-existing conditions, Politico reported.
House Subcommittee to Start Discussing 8 Bills on the Opioid Crisis
The House Energy and Commerce subcommittee will hold a hearing on February 28 to discuss 8 bills released Thursday regarding enforcement-related measures to help stem the opioid crisis. The Hill reported that the hearing is the first of 3 on opioid legislation. Next Wednesday's hearing will focus on balancing enforcement with patient safety. The bills include steps like expanding access to behavioral health telemedicine in rural areas, updating scheduling guidelines on powerful synthetic opioids, letting hospice workers dispose of unused opioids, and more.
Urticaria Diagnosis Challenged by Overlapping Pruritic Skin Conditions
April 23rd 2025Urticaria is complicated to diagnose by its symptomatic overlap with other skin conditions and the frequent misclassification in literature of distinct pathologies like vasculitic urticaria and bullous pemphigus.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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