Government News of the Week
Medicare Compliance, HIPAA, Medicare Advantage and Part D,
Health Care Reform, and Other Federal and State Government Developments
Government News of the Week is a weekly email newsletter with timely news stories from Washington, D.C., and the 50 state capitals. Articles are selected for their impact on hospitals, health plans, medical group practices, physicians and other health care providers. Subscribe now to get an issue delivered to your inbox every Monday!

April 13, 2015

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(1) Aetna Inc. says it is changing the formularies for HIV/AIDS drug coverage in its individual plans effective June 1, with most HIV/AIDS drugs being moved from the specialty tier either to the generic or non-preferred brand tiers in the formulary, which should result in lower costs for most HIV/AIDS medications .... (more)

(2) Vermont’s auditor of accounts said the state’s managed Medicaid program is so disorganized that it can’t even be audited .... (more)

  From the AIS Blogs
  There are some interesting but not necessarily surprising statistics in Prime Therapeutics’ new trend report, which examines the first full year of prescription drug data on enrollees in health insurance exchanges, and compares their pharmacy benefit utilization and cost trends with those of its commercially insured population. Join the conversation at the AIS Blogs.

(3) Humana Inc. said in a Securities and Exchange Commission Form 8-K on March 23 that it believes the Department of Justice (DOJ) investigation into its Medicare Advantage risk-adjustment practices is general in nature and includes other companies .... (more)

(4) During the development of its state-run insurance exchange, Maryland officials misallocated about $28.4 million, HHS’s Office of Inspector General (OIG) explained in a federal audit sent to CMS’s acting Administrator Andy Slavitt .... (more)

  From Congress and the Federal Agencies

(5) CMS on April 2 slapped Aetna Inc. with a $1 million fine for what the agency termed an error-ridden pharmacy directory, which inaccurately listed 6,887 pharmacies as in-network for the 2015 plan year .... (more)

(6) Nevada’s Republican Senate and Assembly want to scrap the Silver State Health Insurance Exchange, Nevada Public Radio reported April 7. Nevada was one of 14 state-based exchanges to launch in fall 2013, but it was plagued with technical problems. That prompted the state to move to the federal IT platform in time for the start of last fall’s open-enrollment period. During the most recent enrollment period, almost 74,000 Nevadans signed up for coverage through the exchange. If the bills are successful, Nevada residents would buy coverage through (From Inside Health Insurance Exchanges' E-Alert)

(7) UnitedHealth Group unit UnitedHealthcare lost its bid to dismiss a class-action lawsuit in California over the insurer’s mental health and substance abuse coverage policies .... (more)

(8) The Internal Revenue Service on April 3 offered exchange enrollees more time to file their tax returns without penalty because of government errors on Form 1095-A, marketplace tax statement. Consumers who are unable to file by April 15 due to problems with the form are advised to file for an automatic extension, and they will be free from any penalty as long as they file a return by Oct. 15. The Treasury Dept. had previously indicated that the filing deadline would not be extended. (From Inside Health Insurance Exchanges' E-Alert)

(9) Several states will experience savings and even gains in their budgets as a result of Medicaid expansion, an April 6 report by the Robert Wood Johnson Foundation (RWJF) concluded .... (more)

(10) In a recent letter to HHS Sec. Sylvia Mathews, Sens. Charles Grassley (R-Iowa) and Orrin Hatch (R-Utah) raised concerns about Andy Slavitt, the acting administrator of CMS, The Hill reported April 1. Prior to joining CMS in June 2014, Slavitt was an executive at Optum, which owns Quality Software Services, Inc. (QSSI), a contractor that works as an advisor to CMS on Both firms are subsidiaries of UnitedHealth Group. It’s not the first time that Republican lawmakers have raised concerns about QSSI’s role in the federal exchanges. In December 2012, Grassley and Sen. Fred Upton (R-Mich.) wrote about concerns over a potential conflict of interest when CMS awarded QSSI a contract to construct and support the operations of a federal data hub. (From Inside Health Insurance Exchanges' E-Alert)


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