Why Medicaid is blocking patient home monitoring

Oct 26, 2022

With Erin Banco and Ben Leonard

Driving the Day

Nurse Kelly DeGraff talks about health monitoring equipment with patient Joe Alini

State Medicaid offices are refusing coverage of remote patient monitoring for low-income residents who suffer from chronic diseases. | Felicia Fonseca/AP Photo

WHY IS MEDICAID STANDING IN THE WAY OF MORE KINDS OF HOME CARE? Many state Medicaid offices are stymieing the use of remote patient care, refusing coverage for low-income residents who suffer from chronic diseases at higher rates than Americans with private insurance, POLITICO's Ruth Reader reports.

Even as successive administrations have touted remote patient monitoring programs as a key to improving Americans' health and reducing unnecessary government spending, many states have declined to pay for them.

The remote care debate: States are hesitant to invest partly because there is disagreement over how cost-efficient and clinically effective remote patient monitoring programs are when broadened to wider populations.

With no common standard for how to use monitoring devices, the data on how useful remote monitoring is for patients with chronic disease is mixed.

But some evidence suggests it works on both fronts. The VA reported in 2018 that patients enrolled in its remote patient monitoring programs saw a 53 percent decrease in "bed days" and a 33 percent reduction in hospital admissions. At the end of 2021, the agency published a request for a proposal for remote patient monitoring contracts worth $1 billion.

But: Proving cost-effectiveness may not be enough to drive the adoption of remote patient monitoring within Medicaid.

While the Centers for Medicare and Medicaid Services has some reimbursement codes for remote monitoring, states have broad discretion to set their own rules. Around 20 states' Medicaid programs don't reimburse for remote patient monitoring, according to data from the Center for Connected Health Policy . Several states that pay for remote monitoring have stringent restrictions around its use.

WELCOME TO WEDNESDAY PULSE — If you have any Bob Evans' Italian pork sausage hanging around, back away slowly from the fridge and check the USDA website. The manufacturer has recalled 7,560 pounds of the product after consumers found blue plastic in it. OK, it's not that gross, but it is weird. Send us the strangest thing you've ever found in your food, news and tips to kmahr@politico.com and dpayne@politico.com.

TODAY ON OUR PULSE CHECK PODCAST, Arizona voters could approve a measure designed to stop creditors from gouging people with medical bills, and other states are taking notice. Megan Messerly talks with Lauren Gardner about the new measure. Plus, David Agus, the Ellison Institute's CEO, on developing digital Covid certificates, green passes and Covid passports.

Listen to today's Pulse Check podcast

Midterms Watch

ARIZONA VOTERS WEIGH MEDICAL DEBT — Arizona voters could approve a measure designed to stop creditors from gouging people with medical bills, POLITICO's Megan Messerly reports .

The scope of the problem: An estimated 875,000 Arizonans — about 12 percent of the state — have medical bills in collections, with the median debt at $719, according to an analysis by the Urban Institute . Nationally, nearly 1 in 10 adults in the U.S. owe medical debt, including 3 million who owe more than $10,000, according to an analysis by the Kaiser Family Foundation .

Why we're watching: Last year, California, Colorado, Illinois, Maryland, Nevada and New Mexico passed bills tackling medical debt. If the Arizona measure passes, the union-backed initiative will likely be replicated in other red states where progressives have successfully pushed ballot measures to accomplish what conservative legislators will not, like expanding Medicaid and establishing paid sick leave.

Coronavirus

VARIANTS DU JOUR — BA.5 is still the dominant variant in the U.S., but three new variants of interest – BQ.1, BQ.1.1 and BF.7 — now collectively make up nearly a quarter of cases ahead of the expected winter rise.

FAKE DEATH CERTIFICATES ROLL INTO FEMA — The team tracking Covid-19 funeral assistance at the Federal Emergency Management Agency has recently identified multiple individuals trying to collect cash by using fake death certificates, Erin reports.

The agency began doling out money last year to help people whose family members died from Covid pay for funerals. As of earlier this year, FEMA had handed out more than $2 billion.

Officials working on the multibillion-dollar program worried early in 2021 about the potential for widespread fraud in a program that would need to address potentially hundreds of thousands of requests for assistance. Two people familiar with the matter told POLITICO that FEMA has received dozens of fake death certificates in recent months from people looking to collect thousands of dollars each for funerals.

A spokesperson for FEMA said the agency "does not count or track the number of fraudulent documents" it receives and that "funds disbursed due to fraudulent activity are not considered accidental payments." The agency said it couldn't answer questions about whether the fake death certificates are connected to one or multiple individuals.

"FEMA established additional controls prior to implementing Covid funeral assistance to mitigate the risk of fraud and identity theft and has required Covid funeral assistance applicants to submit verifiable funeral home contracts, receipts and invoices to verify funeral expenses," the spokesperson said.

FIRST IN PULSE: E&C GOP PUSHES BU ON COVID RESEARCH — House Energy and Commerce Republican leaders wrote a letter on Tuesday to the president of Boston University, raising concerns about the institution's recent Covid-19 research, Ben reports.

The preprint research included combining the original Covid-19 strain with Omicron. The university has slammed reporting that the research was "gain of function" — work that improves the ability of a pathogen to cause disease — as "false and inaccurate," saying the virus actually became less dangerous.

The Republicans — Cathy McMorris Rodgers (R-Wash.), E&C ranking member; Brett Guthrie (R-Ky.), E&C health subcommittee leader; and H. Morgan Griffith (R-Va.), E&C member and Oversight and Investigations subcommittee leader — called on the university to hand over its safety protocols and proposals, among other documents.

The NIH is probing whether the research "should have triggered a federal review," CBS News reported last week .

TEXAS LAWMAKERS BLAST CDC ON VACCINE RECOMMENDATION — Several Texas state legislators sent a letter on Tuesday to CDC Director Rochelle Walensky, blasting the agency after its independent advisers voted to add the Covid-19 vaccine to its list of recommended routine vaccinations for children.

The lawmakers, led by State Rep. Brian Harrison, wrote they were "deeply troubled" by the vaccine's addition to the list and plan to "introduce legislation next session to clearly reject this recommendation for the State of Texas and to publicly rebuff the anti-scientific attempt by unelected bureaucrats to force COVID-19 vaccines on school-age kids."

The Covid vaccine's inclusion on the list is not a mandate, nor does it call for states to mandate the vaccine. Nevertheless, the move has been met with significant backlash in states that have fought CDC guidance throughout the pandemic.

TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO's must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING .

At the Agencies

MORE BLACK AND LATINO AMERICANS COVERED UNDER ACA, HHS SAYS — The number of Black and Latino Americans covered through Healthcare.gov has risen significantly since 2020, according to a new report from HHS released Tuesday .

In 2020, the number of Latino enrollees was 1.7 million compared with 2.6 million in 2022. The trend is similar among Black enrollees, increasing from 900,000 in 2020 to 1.3 million in 2022.

The Biden administration touted a boost to the program's outreach efforts as well as the expanded subsidies from the American Rescue Plan.

The analysis came partly from data that "imputed" the race of many enrollees, as the data was missing for about 30 percent of people in the program. Using census data, along with the enrollee's last name and neighborhood, the method gives a clearer look into the enrollment trends, according to the agency.

A NEW PLAN TO FASTRACK MEDICAL DEVICE COVERAGE — CMS plans to issue a long-awaited proposed rule in the coming months to replace a Trump-era regulation that aimed to create an accelerated coverage pathway for medical devices, POLITICO's David Lim reports.

The new plan, a spiritual successor to the Trump-era effort put on ice at the start of the Biden administration, is expected by April, said Tamara Syrek Jensen, director of the CMS coverage and analysis group, on Tuesday at the MedTech Conference panel in Boston.

Want to know more? CMS Chief Medical Officer Lee Fleisher and CMS Principal Deputy Administrator Jonathan Blum laid out a basic framework for the forthcoming proposed rule earlier this month in JAMA .

Names in the News

Holly Grosholz is now director of government affairs at the American Clinical Laboratory Association. She was most recently director of government relations at the Medical Imaging & Technology Alliance.

Caroline Pearson has been named the new executive director of the Peterson Center on Healthcare.

Marc Rucker is now VP for finance and administration at the Council for Responsible Nutrition. He previously was VP for finance and operations for the American College of Nurse-Midwives.

Mitch Relfe is now principal at Cigna. He previously was at the National Federation of Independent Business.

Ritwik Tewari is the new chief technology officer of Aledade. He previously was senior director of engineering at Meta, where he oversaw the artificial intelligence infrastructure for the company's advertisement platform.

What We're Reading

STAT's Sarah Owermohle reports on the anti-science messaging that's become part of the GOP message on the campaign trail.

Kaiser Health Foundation has released its annual Medicaid budget survey .

Finally, somebody has demystified zombies' hangry, brain-craving behavior. Thank you, Washington Post .

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