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DOJ Has Doubts About Anthem

“The Justice Department has told Anthem Inc. that the health insurer’s planned takeover of Cigna Corp. threatens competition and probably can’t be fixed by selling parts of their businesses.”

“The Justice Department has indicated that it’s open to hearing about proposals from the company to resolve the problems. However, there is the likelihood that the U.S. will sue to block it. The government is on track to make a decision on the combination by around mid-July, according to another person familiar with the matter.

In a written statement this week, Anthem said: ‘Anthem and Cigna continue to be in ongoing dialogue with the Department of Justice and state regulators regarding the compelling combination of our two companies to increase consumer access to high-quality, affordable health care.’ One of the justice department’s key concerns with the Anthem-Cigna deal is that it would reduce options for large employers.”  Source: Benefitspro

CDC Advisory: No Live Flu Vac

The Center for Disease Control’s Advisory Committee has said the Live Attentuated influenza vaccine, (LAIV) FluMist, that is licensed for use in people ages 2-49 years old should not be used during the 2016-17 flu season.  “Their decision was based on data showing that the effectiveness of LAIV from 2013 through 2016 was poor and/or lower than expected, according to a CDC media statement.(www.cdc.gov).”

“In late May, the U.S. Influenza Vaccine Effectiveness Network released preliminary study data on the effectiveness of LAIV in children ages 2-17 during the 2015-16 influenza season that showed the estimated vaccine effectiveness (VE) against any flu virus was 3 percent (with a 95 percent confidence interval [CI] of -49 percent to 37 percent).

“This 3 percent estimate means no protective benefit could be measured,” said the media statement…

“The agency said other non-CDC studies also supported this conclusion that LAIV was far less effective than IIV (inactivated influenza vaccine) this past flu season. The ACIP followed up its overall recommendation against use of LAIV with a vote to specifically recommend that the Vaccines for Children program also should not provide LAIV this upcoming flu season.

“AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., of Wilmington, Deleware, ‘From an evidence-based medicine perspective,’ Savoy said this decision is clearly the right thing to do…In fact, Savoy said, ACIP members discussed the fact that even with needle-phobic, vaccine-hesitant patients, LAIV still could not — in good conscience — be recommended.”  Source: American Academy of Family Physicians.

Indiana to Protect Personal Info

“Indiana missed a deadline to share information with the CMS about how its Medicaid expansion has affected access to care.

“Republican Gov. Mike Pence’s administration said it didn’t trust that the agency could protect the data.

“The missed deadline is the latest in a back and forth between the state and the federal agency, which is trying to gauge the impact of Indiana’s conservative approach to expansion, which includes different levels of coverage and requires beneficiaries to make payments into health savings accounts.

“Pence’s insurance and health policy director, Tyler Ann McGuffee, wrote to the CMS Friday saying she had never received a response from the CMS after inquiring about security measures taken by the agency’s vendors…

“The CMS wants to use data from Indiana’s Medicaid expansion to inform its decision regarding similar requests by Arizona, Kentucky and Ohio, which are considering similar approaches to Indiana’s expansion.

“Indiana officials ‘outlined several concerns about providing personal health information to the CMS vendors that we have no contractual or legal relationship to,’ McGuffee says…

“By June 13, CMS had provided just one of the requested vendor agreements and upon reviewing the document, the state found no provisions requiring the CMS vendors to adhere to state or federal privacy protections and regulations.

“The state has now restated its request to get the agreement of the second vendor and language for both vendors that specifies the required data safety and security measures.

“’While we understand your timeline … we cannot short-change the State’s review process as this could put our citizens’ personal health information at risk and potentially create liabilities for the state,’ McGuffee said in the letter addressed to the CMS.”  Source: Modern Healthcare

CA Gives Aetna the Green Light

“Aetna’s acquisition of Humana is creeping toward the finish line, getting an approval Monday from one of California’s health insurance regulating bodies.

“Aetna’s approval process stands in stark contrast to Anthem’s purchase of Cigna Corp., which has faced more publicized internal and external battles and could be on its way to the chopping block.

“On Monday, the California Department of Managed Health Care gave Aetna the thumbs-up for its $37 billion takeover of Humana, an insurer that has endured many obstacles over the past year and mostly covers seniors through Medicare Advantage. The department mandated Aetna make a few relatively small concessions, such as investing $50 million in various healthcare projects.”  Source Modern Healthcare

New Medicare Lab Payment Rates

“The CMS has finalized a rule under which it will begin paying the same as private insurance rates for clinical diagnostic laboratory tests…

“Medicare’s current fee schedule for lab tests has been in place since 1984 and has been largely unchanged, according to the agency…

Laboratories must collect private payer data from Jan 1, 2016 through June 30, 2016, with reports due to the CMS by March 31, 2017. The CMS will post the new Medicare rates by Nov. 1, 2017.

Hospital stakeholders were pleased with the final rule because the agency widened the base of labs—including some hospital labs—that will be analyzed for payment trends…

“‘Excluding hospital labs from the data also excludes innovative–and expensive–laboratory tests developed at academic medical centers,” said Michelle Cooper, senior vice president and corporate responsibility officer at Catholic Health Initiatives, the nation’s second-largest not-for-profit health system.

“’Including hospital-based labs will better reflect market trends and lead to more appropriate reimbursement,” Nickels said in a statement on the final rule.” Source:  Modern Healthcare

HHS To Limit Short Term

The federal government is aiming to force supposedly “healthier”  people into the ACA exchange insurance market by adding regulations and limits on short term policies.  The federal government regulating and limiting everything pertaining to health insurance needs to stop.

More people will potentially be affected where a lapse in health insurance coverage would occur such as a job change or graduating from college.  Enough is enough.  Source: Modern Healthcare.

UHC Announces Another Exit

“United Healthcare, the largest insurance company in the U.S., struck perhaps its largest symbolic blow yet to the Patient Protection and Affordable Care Act (PPACA). It has announced it will withdraw from California’s insurance exchange.

The company has already said it plans to stop offering plans on a number of state exchanges starting next year, but its abandonment of Obamacare business in the nation’s largest state is by far its largest surrender.”  Source: Benefits Pro.