CMS to Allow Non-Skilled Home Care Benefit in Medicare Advantage


Non-skilled in-home care supports will be included as a supplemental benefit in Medicare Advantage plans in 2019, according to the Centers for Medicare & Medicaid Service (CMS), which announced the policy change Thursday afternoon.

The move marks the first time that CMS has allowed an item or service to be eligible as a supplemental benefit that covers daily maintenance. Along with non-skilled in-home care supports, CMS will also include portable wheelchair ramps and other assistive devices and modifications when patients need them, according to an announcement Thursday.

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” CMS Administrator Seema Verma said in a statement. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”

The new policy enables supplemental benefits if they “compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization,” the announcement reads.

Cancer ‘vaccine’ eliminates tumors in mice

Activating T cells in tumors eliminated even distant metastases in mice, Stanford researchers found. Lymphoma patients are being recruited to test the technique in a clinical trial.

Injecting minute amounts of two immune-stimulating agents directly into solid tumors in mice can eliminate all traces of cancer in the animals, including distant, untreated metastases, according to a study by researchers at the Stanford University School of Medicine.

The approach works for many different types of cancers, including those that arise spontaneously, the study found.

The researchers believe the local application of very small amounts of the agents could serve as a rapid and relatively inexpensive cancer therapy that is unlikely to cause the adverse side effects often seen with bodywide immune stimulation.

“When we use these two agents together, we see the elimination of tumors all over the body,” said Ronald Levy, MD, professor of oncology. “This approach bypasses the need to identify tumor-specific immune targets and doesn’t require wholesale activation of the immune system or customization of a patient’s immune cells.”

One agent is currently already approved for use in humans; the other has been tested for human use in several unrelated clinical trials. A clinical trial was launched in January to test the effect of the treatment in patients with lymphoma.

“All of these immunotherapy advances are changing medical practice,” Levy said. “Our approach uses a one-time application of very small amounts of two agents to stimulate the immune cells only within the tumor itself. In the mice, we saw amazing, bodywide effects, including the elimination of tumors all over the animal.”

Cancers often exist in a strange kind of limbo with regard to the immune system. Immune cells like T cells recognize the abnormal proteins often present on cancer cells and infiltrate to attack the tumor. However, as the tumor grows, it often devises ways to suppress the activity of the T cells.

Levy’s method works to reactivate the cancer-specific T cells by injecting microgram amounts of two agents directly into the tumor site. (A microgram is one-millionth of a gram). One, a short stretch of DNA called a CpG oligonucleotide, works with other nearby immune cells to amplify the expression of an activating receptor called OX40 on the surface of the T cells. The other, an antibody that binds to OX40, activates the T cells to lead the charge against the cancer cells. Because the two agents are injected directly into the tumor, only T cells that have infiltrated it are activated. In effect, these T cells are “prescreened” by the body to recognize only cancer-specific proteins.

Lifestyle Changes Prevent Cognitive Decline Even in Genetically Susceptible People

Enhanced lifestyle counselling prevents cognitive decline even in people who are carriers of the APOE4 gene, a common risk factor of Alzheimer’s disease, according to a new study published in JAMA Neurology.

The two-year FINGER trial involved 60-77 year-old people living in Finland and with risk factors for memory disorders. The study participants were divided into two groups: one of the groups was given regular lifestyle counselling and the other enhanced lifestyle counselling. Enhanced counselling involved nutrition counselling, physical and cognitive exercises, and support in managing the risk of cardiovascular diseases.

Earlier findings from the FINGER trial have shown that the regular lifestyle counselling group had a significantly increased risk of cognitive and functional impairment compared to the intervention group, i.e. the group receiving enhanced counselling.

Now the researchers analysed whether the presence of the APOE4 gene affected the intervention results. The analysis included 1,109 persons of whom 362 were carriers of the APOE4 gene. The findings show that enhanced lifestyle counselling prevented cognitive decline despite the presence of the risk gene. Analyses carried out within the groups also indicate that the intervention results might even be better in carriers of the APOE4 gene.

A New Zealand City the Size of Berkeley, CA, Has Been Studying Aging for 45 Years. Here’s What They Discovered

The Dunedin Study, which began as a study of childhood development, has become one of humanity’s richest treasure troves of data on what makes us who we are.

The Dunedin Multidisciplinary Health and Development Study, which began more than four decades ago, has
generated data used in the publication of some 1,200 scientific papers.
→ It's an example of a longitudinal study, in which data related to a group of individuals are 
observed and recorded over a long period of time.

→ Findings from the study have taught us about the connection between self-control and success in life, the prevalence of mental illness, and identified many biological markers of aging.

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Gut Microbes Involved in PCOS?

Polycystic ovary syndrome (PCOS) was linked with changes in the gut microbiome, a finding that might lead to novel treatments, scientists said.

Women with PCOS had a reduced overall number of bacterial species and lower phylogenic diversity in their gut microbes compared with a healthy control group (P<0.05), said Varykina Thackray, PhD, of the University of California San Diego, and colleagues.

he biodiversity of gut microbes in women with PCOS correlated with hyperandrogenism, the group found. More specifically, it strongly and negatively correlated with total testosterone levels (P=0.006) and hirsutism (P=0.02), Thackray and colleagues reported online in the Journal of Clinical Endocrinology & Metabolism.

Women with polycystic ovarian morphology (PCOM), but not PCOS, had changes in gut microbiome diversity that were intermediate between the control and PCOS groups, Thackray and colleagues said.

In women with PCOS, the relative abundance of Porphyromonas spp., Bacteroides coprophilusBlautia spp., and Faecalibacterium prausnitzii was consistently higher, while Anaerococcus spp., Odoribacter spp., Roseburia spp., and Ruminococcus bromii were lower, the study found. The four types of bacteria found in lower abundance are all known to synthesize short-chain fatty acids, which are involved in processes such as downregulation of bacterial virulence, maintenance of colonic homeostasis, and anti-inflammatory effects, the study authors said.

The current study confirms the results of two other recent studies, one conducted in Austria and the other in China, that also tied changes in the gut microbiome to PCOS, Thackray and colleagues said.

"Our findings suggest that androgens may be an important factor in shaping the gut microbiome, and that changes in the gut microbiome may influence the development and pathology of PCOS," the study authors wrote. "If hyperandrogenism drives the microbial composition of the gut, it would be interesting to determine if treatment of PCOS with androgen antagonists or oral contraceptives results in recovery of the gut microbiome and improvement of the PCOS metabolic phenotype."

Trump Signs Family Caregivers Act

A new law will require the federal government to develop a national strategy to address the needs of family caregivers, including those supporting people with developmental disabilities.

President Donald Trump signed legislation this week known as the Recognize, Assist, Include, Support and Engage, or RAISE Family Caregivers Act.

The law calls for the secretary of health and human services to establish a national plan to “recognize and support family caregivers” within 18 months. The plan is supposed to include recommendations for federal, state and local governments as well as health care and long-term services and supports providers. The strategy is to be updated every other year.

Additionally, the legislation also creates a family caregiving advisory council comprised of federal officials and stakeholders in the community to guide the strategy’s development and advise the secretary and other members of government on how to support the more than 40 million family caregivers across the country.

The bipartisan legislation received broad support from disability advocacy groups including the The Arc, the Autism Society, the Autistic Self Advocacy Network, Easterseals and United Cerebral Palsy, among others.

SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs

New and emerging research links the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the nation’s most important anti-hunger program, with improved health outcomes and lower health care costs. This research adds to previous work showing SNAP’s powerful capacity to help families buy adequate food, reduce poverty, and help stabilize the economy during recessions.

SNAP is the primary source of nutrition assistance for many low-income people. In a typical month of 2017, SNAP helped about 42 million low-income Americans afford a nutritious diet. It provides important nutritional support for low-wage working families, low-income seniors, and people with disabilities living on fixed incomes: close to 70 percent of SNAP participants are in families with children, and more than one-quarter are in households with seniors or people with disabilities. While SNAP provides only a modest benefit — just $1.40 on average per person per meal in 2017 — it forms a critical foundation for the health and well-being of low-income Americans, lifting millions out of poverty and improving food security.

Flu Season Just Keeps Getting Worse

Flu deaths surpassed the epidemic threshold at the end of December, with pediatric flu-related deaths also up, according to data from the CDC.

The CDC's weekly FluView surveillance report found that pneumonia- and influenza-related mortality comprised 8.2% of all deaths in the last week of December. This was above the epidemic threshold of 7.1%.

Outpatient influenza-like illnesses were up, and continued to spread across the country. Data from this week indicates that 6.3% of reported patient visits were due to influenza-like illness (up from 5.8% a week ago). Thirty-two states now reported experiencing high influenza-like illness activity versus 26 states a week prior, and influenza remains widespread in 49 states -- Hawaii being the lone exception.

Biologics Prove Best for Psoriasis Patients

Although all major treatment classes reviewed in a Cochrane meta-analysis were more effective than placebo for moderate to severe psoriasis, biologic agents appeared to be the most efficacious.

The researchers found that all of the anti-IL17 drugs and guselkumab (Tremfya) were more effective than the anti-TNF alpha drugs infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel) for reaching PASI 90 status.

Ustekinumab (Stelara, an IL-12/23 inhibitor) was better than etanercept but there was no clear difference between infliximab, adalimumab, and etanercept. Tofacitinib (Xeljanz, a small molecule) was superior to methotrexate (a conventional systemic agent), but there was no difference between the other small molecules and conventional drugs.