Last month, the Massachusetts Office of Health and Human Services submitted a Section 1115 Demonstration Waiver proposal to CMS to restructure the state's Medicaid program, known as MassHealth. These kinds of waivers allow state Medicaid programs to put aside certain federal Medicaid requirements in order to test and evaluate new delivery models and also receive federal matching funds. The federal government must approve the waiver before it can be implemented.

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Among many proposed changes, Massachusetts is seeking to move nondisabled adults with incomes above the federal poverty level (FPL) out of MassHealth and into subsidized commercial plans through the state's marketplace. Under Medicaid expansion in the ACA, individuals up to 138 percent of FPL are eligible for Medicaid coverage. Massachusetts also requested authority to adopt a commercial-style closed formulary with minimum coverage of just one drug per therapeutic class, a limited specialty pharmacy network and an exclusion policy toward new drugs.

The AMA submitted comments (PDF) on the proposal, expressing concern that some elements of the proposal may decrease access to affordable coverage and jeopardize the health and welfare of low-income patients.

The Centers for Disease Control and Prevention (CDC) last week released a new report that found illicitly manufactured fentanyl is a key factor driving opioid overdose deaths. Key findings in the report, "Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700—10 States, July–December 2016," included:

  • At least half of opioid overdose deaths in six of the seven participating states east of the Mississippi tested positive for fentanyl.
  • More than half the overdose deaths involving fentanyl and fentanyl analogs tested positive for confirmed or suspected heroin, cocaine or methamphetamine.
  • Nearly half of overdose deaths involving fentanyl and fentanyl analogs, however, did not test positive for other illicit opioids, suggesting that fentanyl and fentanyl analogs might be emerging as unique illicit products.

This new CDC data come on the heels of provisional drug-overdose death counts released from the CDC showing that fentanyl-related overdose has become the leading cause of opioid-related mortality, with deaths nearly doubling to more than 21,000 from March 2016 to March 2017.

The American Academy of Pediatrics released two new continuing medical education (CME) courses to help physicians better understand and treat acute and chronic pain management and appropriate use of opioids. The first course provides information about the types of chronic pain and approaches to treat chronic pain in pediatrics as well as Centers for Disease Control and Prevention (CDC) recommendations for opioid therapy in the chronic pain population.

The AAP also released, "Acute Pain Management: Changes and Challenges," which has among its goals to increase the number of pediatricians who understand how to assess and treat pain as well as how to identify patients at risk for misusing and abusing opioid medications. The course presents case studies to provide the opportunity to apply the pain screening and management techniques to patient and family case situations.

Additional resources from the AAP can be found on the AMA opioid microsite.

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