June 17, 2013

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(1) CMS on May 31 released a final rule on the Small Business Health Options Program (SHOP) that confirms an earlier rule limiting the number of plan options available to small-business employees on federally facilitated insurance exchanges next year. In 2014, state-run SHOPs will have the flexibility to decide whether employers will have multiple plans or just one plan to choose from, CMS said. The federally facilitated SHOP, however, will let employers choose only one plan from a range of plans to offer their employees in 2014, the agency added. In 2015 onward, all SHOPs will allow small businesses to let their employees choose coverage from multiple plans. (Reprinted from AIS’s Health Reform Week's e-News Alert)

(2) Seven individuals, including the president of Biodiagnostic Laboratory Services in New Jersey, each pleaded guilty to one count of conspiracy to violate the anti-kickback statute and the Federal Travel Act and one count of money laundering.... (more)

(3) Almost six months following the filing of a lawsuit over how Anthem Blue Cross members get their HIV/AIDS drugs, a settlement finally has been reached.... (more)

(4) The New York attorney general’s office asked 15 health plans based in that state to allow members to get their specialty drugs at retail pharmacies instead of through mandatory mail order.... (more)

(5) Ohio finally received on May 23 information on the Medicare portion of the payment rates it will pay health plans participating in its CMS-backed demonstration program for Medicare-Medicaid dual eligibles that is slated to start Oct. 1.... (more)

(6) Lawmakers in Michigan and Arizona are moving closer to approving measures that would expand Medicaid eligibility under the Affordable Care Act (ACA). Bills to expand the program are expected to be voted on this week in both states. Michigan Gov. Rick Snyder (R) and Arizona Gov. Jan Brewer (R) are among a handful of GOP governors who support Medicaid expansion, in which the federal government would pay 100% of the additional costs in the first three years, and taper off to 90% in subsequent years. Expansion in Michigan would cover up to 320,000 additional residents, according to a June 10 article in The Battle Creek Enquirer. Supporters in Michigan say a deal is within reach, according to the article. Expansion in Arizona would cover roughly 300,000 more people, according to the Associated Press. Moderate House Republicans in Arizona were poised to join all 24 Democrats in passing the measure, the AP said. (Reprinted from AIS’s Health Reform Week's e-News Alert)

(7) Two California state senators have introduced a bill (SB 332) that would remove some of the state’s ability to conceal vendor contracts related to the state’s insurance exchange.... (more)

(8) A Franklin County Circuit Court judge in Kentucky ruled May 31 that Centene Corp. “does not have the contractual right to terminate its Medicaid managed care contract with the state before the end of the initial term.”... (more)

(9) Siemens Healthcare, a company that prints and mails doctors’ bills on behalf of LSU Health Shreveport, and LSU Health notified roughly 8,330 patients on May 15 of a computer issue that resulted in an unintentional disclosure of PHI.... (more)

(10) CMS is counting on its revised Medicare Summary Notice to help seniors spot fraud on their Medicare bills.... (more)

(11) A U.S. District Court in Oklahoma has scheduled oral arguments for June 20 to determine whether the employer mandate and federal premium assistance offered to exchange enrollees are allowed in states where the exchange is operated by the federal government... (more)

(12) In a May 10 letter, Indiana University Health Arnett, Inc. told 10,300 affected patients of a health data breach.... (more)

(13) A federal jury in Tampa, Fla., on June 10 found three former executives of WellCare Health Plans, Inc. guilty of charges related to an alleged scheme to defraud Florida’s Medicaid program.... (more)

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