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New Hampshire is Next!

“The CMS on Monday, May 7th, gave New Hampshire the green light to impose work rules for some adult Medicaid recipients. It’s the fourth state to win approval for that requirement.

“The state’s Medicaid 1115 waiver will require adult beneficiaries between the ages of 19 and 64 to participate in 100 hours of “community engagement activities” a month to maintain eligibility for coverage. Community engagement is defined as having a job, being enrolled in school, participating in job skills training, or performing some sort of community service.

“‘Today’s announcement by the CMS … is a transformative step towards a more thriving workforce,’ Gov. Chris Sununu said in a written statement. ‘Work requirements help lift able-bodied individuals out of poverty by empowering them with the dignity of work and self-reliability while also allowing states to control the costs of their Medicaid programs—we are committed to helping more people get into the workforce, as it is critical not only for individuals but also for our economy as a whole.'”
Source: Steven Ross Johnson, Modern Healthcare.

CMS Encourages Innovation!

On Monday April 9, 2018 the Centers for Medicare and Medicaid finalized the rule that “eliminates (Affordable Care Act) standardized options starting in 2019 to encourage innovative plan designs among insurers.”

This is a good move for the coming years in the, non-Medicare, individual/family health insurance markets of America!  This change indicates that our current government recognizes that health insurance plans are not a one-size-fits-all financial product.  We have been saying this all along and CMS Director Verma has now been quoted saying as much- and we are thankful.

At this time it is unclear if ACA-compliant plans this fall, for the 2019 calendar year, will reflect this change in standardization requirements, and make health insurance plans more reflective of the coverage needs of the people in each state.  However, since the standardization requirements are eliminated in 2019- we do expect the individual/family plans, for the 2020 calendar year, to be more fitted to each state.

As everyone anticipates smart changes coming in the years ahead to the individual/family health insurance market we should be aware that according to Director Verma, the states are still subject to the ACA requirement that insurers offer 10 essential health benefits.  Although the standardization requirements are eliminated, this doesn’t mean states can allow ACA-compliant plans to exclude maternity care or mental health benefits.

We do expect to have more appropriate premiums and coverage choices for individuals and families in the coming years.  All in all, a good day.

Reference: Shelby Livingston and Susannah Luthi, Modern Healthcare.

New to Medicare: Some DNA Tests

“The CMS announced Friday that it will cover diagnostic laboratory tests using gene sequencing technology for Medicare cancer patients.

“The CMS said the tests — called next generation sequencing — can help patients and their oncologists make better treatment decisions as well as help more patients enroll in clinical trials. Patients with recurrent, metastatic, relapsed, refractory or stages III or IV cancers will be eligible to get the tests covered under Medicare, according to the agency.

“‘We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways,’ said CMS Administrator Seema Verma in a statement. ‘That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve.’

“The CMS’ decision to cover such tests comes shortly after the FDA’s recent approval of Foundation Medicine’s genomic profiling test called FoundationOne CDx. The CMS worked with the FDA to review the effectiveness of the test.” Source: Maria Castellucci, Modern Healthcare.

Changes in Cardiac Device Coverage

CMS, the Centers for Medicare and Medicaid, has finalized its changes to its Medicare coverage of implantable cardiac devices, which should reduce the wait-times required to get the implantation procedure done and cut the regulatory burden for providers that use the devices for their patients.

This “is the first major change to Medicare’s implantable cardioverter defibrillator, or ICD, coverage in more than a decade. The CMS wants to reduce some of the barriers to care outlined in its most recent coverage determination, issued in 2005.

“The CMS is eliminating waiting periods for device implantation and dropping a policy that requires patients to be tracked in a registry.”

“It is also requiring shared decision-making, which the agency said would empower patients…

“The agency is also looking to hasten access to ICDs by allowing patients with an existing ICD who suffer a heart attack or undergo a coronary revascularization procedure to obtain a replacement device without waiting. Previously, the devices could not be implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty…

“ICDs have been used since the 1980s, and the CMS began covering them in 1986. Initially, they were mostly used in patients with recurrent cardiac arrest who were not responsive to drug treatments. In 2005, the agency finalized coverage for primary prevention of arrhythmia.

“The devices are wired to the heart and deliver an electric shock if they detect an abnormal rhythm. They are a significant revenue driver for hospitals. It’s estimated that 10,000 ICDs are implanted every month, and the average hospital stay after placement is eight days. That generates an average of $12,423 in hospitalization costs per patient.”
Source: Virgil Dickson, Modern Healthcare.

Kentucky Leads the Way!

“Kentucky has become the first state in the nation to receive federal approval to impose work requirements as a condition of Medicaid coverage.

“Nine other states—Arizona, Arkansas, Indiana, Kansas, Maine, New Hampshire, North Carolina, Utah and Wisconsin—have also applied for the Section 1115 waivers.

“In the coming weeks, adult beneficiaries in Kentucky between 19 to 64 will be required to complete 80 hours per month of community engagement activities, such as employment, education, job skills training, and community service to maintain their Medicaid eligibility.

“Former foster-care youth, pregnant women, primary caregivers of a dependent, beneficiaries considered medically frail and full-time students are exempt from the new requirements.

“Kentucky will lock beneficiaries out of coverage for noncompliance. A person’s coverage can only be reactivated on the first day of the month after they complete 80 hours of community engagement in a 30-day period.

“If a suspended beneficiary hasn’t met the work or volunteering requirement by their redetermination date, their Medicaid enrollment will be terminated and they will have to submit a new application to rejoin Medicaid.

“The CMS also approved Kentucky’s request to impose premiums on expansion beneficiaries and parents and other family caretakers in the state.

“Non-payment over a 60-day period will result in a six-month lockout from coverage.

“Enrollees will also lose coverage if they don’t report income changes quickly.

“The approval also allows Kentucky to end retroactive coverage for Medicaid beneficiaries.

“The new waiver nixes providers’ ability to bill for services provided in the three months before the application, assuming the patient was eligible during that time.

“Finally, Kentucky has gained permission to continue not covering non-emergency transportation services.

“As of October 2017, Kentucky has more than 1.2 million people in Medicaid and the Children’s Health Insurance Program, a net increase of 108% since Medicaid expansion under the ACA, according to the CMS.”
Source: Virgil Dickson, Modern Healthcare.

Approved! Glucose Monitor: No Sticks

In what could be the a huge relief for millions in America with Type 1 or Type 2 diabetes- the FDA has approved the first glucose monitor that doesn’t require a person to stick themselves with a needle daily, or regularly, to keep an eye on their blood sugar levels.  This is a major advancement in the healthcare industry because of the potential ease of use, the lack of additional durable medical equipment like testing strips and needles.   Not to mention that this has the potential to monitor glucose over time more accurately than just taking a one-moment-in-time kind of measurement.  For more details click here.

Scammers Pretend to Be NIH

Please be aware.  It is being reported that scammers are now pretending to be with the National Institutes of Health (NIH).  The NIH is a government agency.   These scammers are offering “grants” of money in exchange for your bank account info or a prepaid iTunes card- yeah.  Supposedly by giving this info to the caller it will remove any red-tape for receiving the grant funds, or something like fast-tracking you to receive the grant.

Grants are never given by the NIH for personal use under any circumstances and to be considered for a real grant, a researcher has to actually apply for the grant.  The NIH doesn’t just call you.  Again, scammers never sleep apparently.  It’s unbelievable the pitches they think up.  Please be aware.  Hang up immediately if you get one of these calls.  Source: STAT, Federal Trade Commission.

For more details click here.

Update: Large Employer Insurance

“Consumers who get health insurance through their jobs won’t see rate hikes in the double digits like those on the Obamacare exchanges, but they’ll still see the cost of health care go up.

“Large employers estimate that the employee share of health insurance costs next year will be $4,400, up from $4,200 this year, according to a new report from the National Business Group on Health. On average, employers will continue to cover about 70 percent of the total costs, which they project will increase by 5 percent to $14,156.

“As the price of insurance continues to go up, more companies are looking into different kinds of plans. If your company doesn’t offer a high-deductible health insurance plan, it probably will soon.

“The plans, which shift some costs from the company to the worker and encourage consumers to shop around for health care, are becoming far more common. In 2018, nine in 10 large employers will offer at least one high-deductible health plan, up from 84 percent last year, according to NBGH.”  Source: Beth Braverman, Financial Times.

Guideline:  Large Employers have 50 or more full-time equivalent employees (working 30 or more hours per week).

Currently almost 4 out of every 10 companies have only high-deductible health plans as their only plans available for employees.  This trend is predicted to continue across America, with about 97% of large employers making a high-deductible health plan an option for employees to keep their premium cost lower.

The National Business Group on Health has also found trends in large employers offering plans with tele-medicine available and providing onsite health centers for treatment of minor medical issues.


Firehouse Subs Serving Breakfast

“Firehouse of America LLC debuted a non-traditional Firehouse Subs restaurant on July 1, in the Jacksonville International Airport in Florida, becoming the chain’s first domestic location to serve breakfast…

“‘We’ve done a couple of one-off locations like arenas in the past, but this is the first one that I would say is a long-term engagement,’ Firehouse CEO Don Fox told Nation’s Restaurant News on Wednesday. ‘We hope this may be the first of many.’…

“The Jacksonville, Fla.-based brand, which has 1,084 restaurants in 44 states, Canada, Mexico and Puerto Rico, may move more aggressively into non-traditional airport, college, military and stadium venues, he said. The new airport unit is located in a secured-area food court…

“The new airport unit is also a homecoming of sorts for Firehouse Subs’ co-founding brothers Robin and Chris Sorensen.

“‘As Jacksonville natives and former firefighters with Aircraft Rescue and Firefighting at Jacksonville International Airport, my brother Chris and I are eager to serve guests at our hometown airport,’ Robin Sorenson said in a statement.” Source: Nations Restaurant News.

Scammers Still Impersonate IRS

Scammers never sleep.  We don’t know how they can sleep at night doing what they do, but there are still several scams going on where the caller is impersonating the IRS.

Current Scams still occurring include:

-Private debt collectors calling to collect past due taxes, pretending to be in partnership with the IRS.

-Con artists calling you and demanding you pay back taxes with a pre-paid debit card supposedly connected the the Electronic Federal Tax Payment System,  but which is their debit card getting your money instead of the IRS.

-Robo-calls demanding you pay your taxes or you will be arrested.  NOTE:  The IRS never leaves pre-recorded messages for anyone.

-Thieves calling taxpayers with limited English-speaking skills calling and speaking in their native languages claiming they will be deported if they do not pay their taxes.

We know the next schemes to come will likely be different, but for now- these are just some of the ones to watch for.   Please be aware and be safe.

If you did not call the IRS yourself to resolve a matter, or to get/give tax payment information, Do Not Give Anyone any information about your household, or the names of people in it, or any personal information, or banking information.  If you have any questions about someone calling you for payment, please contact your local IRS office and alert your bank if you feel that you may have given the caller any bit of your banking information.

Source:  Financial Times.