California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

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CMS’ Sweeping Medicaid Managed Care Rules Set New Quality Standards

The long-awaited regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how large insurance contractors who administer care for some of the most vulnerable patients.

Modern Healthcare: 85% Medical-Loss Ratio In Final Managed Medicaid Rule
The CMS has finalized a long-awaited rule that will overhaul managed Medicaid, which has not been updated in a decade. The sweeping 1,425-page rule, which was proposed last May, caps insurer profits, requires states to more rigorously supervise the adequacy of plans' provider networks, encourages states to establish quality rating systems for plans, allows more behavioral healthcare in institutional settings and promotes the growth of managed long-term care. But the CMS deferred to state control for several issues. (Dickson and Herman, 4/25)

The Associated Press: Feds Issue New Standards For Medicaid Insurance Plans
The Obama administration Monday set new standards for Medicaid private insurance plans, which in recent years have become the main source of coverage for low-income people. The rules apply to insurers operating as Medicaid middlemen in 39 states and Washington, DC. Each state runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years. (4/25)

In other national health care news —

Modern Healthcare: Health Insurer Execs Reap Massive Rewards In Deal-Heavy 2015
UnitedHealth Group CEO Stephen Hemsley UnitedHealth Group CEO Stephen Hemsley earned $14.5 million in 2015, according to a filing Friday, but he wasn't the top-earning health insurance executive. Centene completed its $6 billion deal for Health Net in March after a protracted review from California regulators. The acquisition opened up Centene to bigger plays in Medicare Advantage and the ACA exchanges, and it fortified the company's position as one of the largest, most powerful Medicaid insurers in the country. The company cited Neidorff's role in the Health Net deal, along with Centene's increased profitability, as the major reasons for his $3.6 million cash bonus. (Herman, 4/25)

Reuters: Valeant Names Papa CEO After He Resigns From Perrigo
Former Perrigo Co Plc head Joseph Papa was named Chief Executive Officer at Valeant Pharmaceuticals International on Monday, a role in which investors said he should focus on returning the company to growth. Papa will replace CEO Michael Pearson, whose years of frenzied dealmaking fueled double-digit profit increases at Valeant until scrutiny of its controversial relationship with a specialty pharmacy and history of sharp drug price increases hit its shares and sales last fall. (O'Donnell, Roumeliotis and Humer, 4/25)

The New York Times: Advisers To F.D.A. Vote Against Duchenne Muscular Dystrophy Drug
In a confrontation between the hopes of desperate patients and clinical trial data, advisers to the Food and Drug Administration voted on Monday not to recommend approval of what would become the first drug for Duchenne muscular dystrophy. The negative votes came despite impassioned pleas from patients, parents and doctors who insisted that the drug, called eteplirsen, was prolonging the ability of boys with the disease to walk well beyond when they would normally be in wheelchairs. (Pollack, 4/25)

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