Aetna/CVS defends proposed merger before California Department of Insurance

This Weekly’s Hot Topics

  • Aetna/CVS defends proposed merger before California Department of Insurance (California News)
  • Final resolution on the denials of 96402 from CMS (MOASC News)
  • American Medical Association House of Delegates approves several ASCO-led resolutions (National News)

CVS Health and Aetna executives defended their $69 billion proposed merger before the California insurance commissioner, as a panel of antitrust experts and healthcare providers chipped away at the companies’ promise to lower U.S. healthcare costs and improve the quality of care without harming competition. The American Medical Association has urged regulators to block the proposed acquisition of health insurer Aetna by retail pharmacy and pharmacy benefit manager CVS Health. For more information click here and go to California News.

While the Aid-In-Dying law faces an uncertain future, state officials released numbers last Friday showing an increase in deaths from 16.5 per month in 2016 to 31.2 in 2017.  According to data compiled by the California Department of Public Health, more than 90 percent of individuals were 60 or older and about 89 percent were white. For more information click here and go to California News.

MOASC has acquired a final resolution on the denials of 96402 from Neal E. Logue, Health Insurance Specialist, Division of Financial Management and Fee for Service Operations, Centers for Medicare & Medicaid Services (CMS), CMS San Francisco Regional Office. For more information click here and go to MOASC News.

During the American Medical Association (AMA) House of Delegates (HOD) annual meeting, delegates approved several ASCO-led resolutions and incorporated them into the AMA’s policy agenda.  For more information click here and go to National News.

To view the complete California Oncology Weekly Newsletter, click on the date below.

June 26, 2018 

This Weekly’s Hot Topics

  • California state appeals court issues stay, End of Life Option back in effect. (California News)
  • The Trump Administration is seeking stakeholder feedback. (National News)
  • Submit ideas by June 29for CMS’ Promoting Interoperability (CMS News)

The state appeals court has issued a stay, at least for now, putting California’s End of Life Option back into effect. California’s law, allowing terminally ill people to end their lives, was declared unconstitutional last month by a judge because it was voted on during a special session. For more information click here and go to California News.

Rep. Doris Matsui (D-CA) introduced a provider-friendly bill to reform the 340B drug discount program, including explicitly laying out a purpose for the 340B program that says hospitals do not necessarily have to forward drug discounts to patients and reversing the CMS cut to hospitals’ Medicare reimbursement for 340B drugs. For more information click here and go to MOASC News.

The Trump Administration is seeking stakeholder feedback on the American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. The document identifies challenges in the American prescription drug market, such as high list prices for drugs, and high and rising out-of-pocket costs for consumers. For more information click here and go to National News.

Last week, CMS released updates to the Merit-based Incentive Payment System (MIPS) eligible clinicians by updating the MIPS Participation Lookup Tool and renaming it the Quality Payment Program (QPP) Participation Lookup Tool and adding predictive Qualifying APM Participant (QP) status. Eligible clinicians in Advanced Alternative Payment Models (APMs) who meet certain criteria are considered QPs and are excluded from MIPS. For more information click here and go to CMS News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

June 19. 2018

This Weekly’s Hot Topics

  • June is Men’s Health Month. (National News)
  • CMA & Blue Shield of California announce project focusing on support of independent physicians (California News)
  • CMS to investigate Noridian 96402 denials (MOASC News)

Gov. Jerry Brown and Democratic legislative leaders struck a $200 billion budget deal last Friday that rejected two proposals that would have expanded access to health care and tax breaks to undocumented Californians. The agreement puts the Legislature on track to meet its deadline to pass a budget by June 15. For more information click here and go to California News.

NEXT Tuesday, June 19th CAPP/MICRA Supporters are invited for an evening reception, to mix and mingle with California Republican Caucus members, including Senate Republican Leader Patricia Bates and Assembly Republican Leader Brian Dahle. The reception will be held at the California Dental Association’s 15th Floor Rotunda, 1201 K Street, Sacramento, from 5:00 p.m. – 6:30 p.m. For more information click here and go to California News.

MOASC has communicated with Noridian regarding 96402 denials. The most recent response from Noridian is, “…Claims are being adjusted.  Noridian does not have the timeframe on this.  Noridian would suggest calling the call center in case they have more information. It takes a while to get these processes done.  Noridian expects that any claims submitting going forth should process correctly, but physicians and providers may want to test a few before submitting a batch…” MOASC still waits for a Production Alert to be posted, but it has not been at this time. For more information click here and go to MOASC News.

June is Men’s Health Month. This month-long observance is an opportunity for men to take command of their health. According to the Centers for Disease Control and Prevention, the leading causes of death among men in the U.S. include heart disease, cancer, respiratory diseases, and stroke. For more information click here and go to National News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

June 12, 2018