In this summary, you’ll find information on the federal government’s extension of the deadline for states to submit plans for health insurance exchanges, new developments in Alzheimer’s research, expansion of a NYS biotech company, and more!
Affordable Care Act
The New York Times reported late last week that the Department of Health and Human Services extended the deadline for states to submit their plans for health insurance exchanges under the Affordable Care Act. With the fate of health care reform unsettled until after the Presidential election, many states had not moved forward with development of these exchanges. Recognizing that many states would be unable to comply with the original November 16th deadline, the Department of Health and Human Services will give states until December 14th to submit the more detailed applications. However, if a state wants to run its own exchange, its governor still must submit a brief declaration of intent by Nov. 16th (Pear, 11/9). On Wednesday, the Leaders of the Republican Governors Association, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk about the development of exchanges (New York Times, Goodnough & Cooper, 11/14) .
Late on Thursday, the President and the Department of Health and Human Services responded to the request for more time by extending the deadline. Kathleen Sebelius, the Secretary of the Department of Health and Human Services, sent a letter to the Republican Governors Association and conveyed that states would have until December 14th to let the administration know about whether they wanted to establish their own health insurance exchanges. If a state chooses not to establish an exchange the federal government will step in to run one.
In order to assist Medicare recipients impacted by Hurricane Sandy, the Centers for Medicare and Medicaid Services (CMS) extended this year’s open enrollment deadline for Medicare. Beneficiaries must call Medicare at (800) 633-4227 to get an extension and each individual’s circumstances will be evaluated to determine the best course of action. CMS also issued guidance that because of federal disaster declarations, Medicare drug plans must allow enrollees to get covered prescriptions at out-of-network pharmacies when they cannot get them at their usual pharmacy.
As open enrollment season draws near, the Wall Street Journal highlights trends in insurance offerings for consumers. Many plans seek to incentivize consumers to improve their own health in an effort to reduce consumer and employer insurance costs. Some companies are moving toward giving workers a fixed sum of money to select their own plans in health-insurance marketplaces. Other companies are combining high deductible plans with health savings accounts (Mathews, 11/11).
A new report from the Inspector General at the Department of Health and Human Services details inappropriate payments to nursing homes. The report found that hundreds of nursing homes overcharge Medicare for skilled services adding $1.5 billion in annual costs to the program. About one-fourth of Medicare bills from facilities examined in the report were incorrect. The majority of these claims involved upcoding, where a nursing home or other provider inflates the cost of its bill to Medicare by claiming more intensive services were done than actually performed. In other cases, nursing homes provided treatments that were inappropriate.
The Inspector General at the Department of Health and Human Services issued a second report this week which examined the problems of fraud within the Medicaid personal-care program. The report brings together six years of Inspector General investigations and 23 reports. The report contributed the growth in fraud to both lax requirements for caregivers and patients as well as poor state and federal oversight for the program.
Two groups of researchers have made a discovery in the battle to develop a treatment for Alzheimer’s disease. The research was published this week in the New England Journal of Medicine. For many years those studying Alzheimer’s disease have focused on the production of toxic protein that accumulates in plaques on the brain. However, researchers have recently found that a mutated gene may play a role in another aspect of Alzheimer’s disease: the immune system’s role in protecting against the disease. The mutation is suspected of interfering with the brain’s ability to prevent the buildup of plaque. The discovery of this mutation could lead to the development of a treatment to enhance the gene’s activity to stimulate immune defense activity to fight the dangerous plaque.
A new study on Lyme disease, a bacterial infection, has found that repeat symptoms of the disease are from new infections, not from relapses. This conclusion was based on genetically fingerprinting the Lyme bacteria in people who have had the illness more than once. The fingerprints did not match meaning that the episodes of Lyme in each patient were caused by different strains of bacteria and could not be relapses. This study is likely to be controversial among patients and practitioners that believe Lyme disease has a tendency to resist the usual antibiotic treatment and turn into a chronic illness (ABC News, Gever, 11/15).
USA Today profiles the long-term care insurance industry and the challenges some consumers face when selecting a plan. The industry has struggled to keep premiums in check and provide the benefits consumers need as they age. The recent exit of a number of insurance carriers has put an additional strain on the market (Dugas, 11/13).
Regeneron Pharmaceuticals is planning a $70 million investment that will add 300 jobs to its operation in East Greenbush, near Albany. Gov. Cuomo made the announcement on Tuesday, touting the company as being the largest in the state’s growing pharmaceutical industry (Associated Press, 11/14).
-Jaime Venditti, 11/17/12