CMS finalized a decision to provide Medicare coverage for chimeric antigen receptor (CAR) T-cell therapy, which is an FDA-approved gene therapy used to treat non-Hodgkin lymphoma and B-cell precursor...
Yesterday, CMS announced a proposed rule that would cut down the regulatory burden for long-term care (LTC) facilities and released a finalized rule which updated the requirements for nursing home...
As the 5th Circuit deliberates whether the Affordable Care Act is constitutional — particularly the severability of individual mandate to acquire essential coverage — here are some of the...
A federal judge recently ruled in favor of a group of pharmaceutical companies challenging a new drug price transparency rule from HHS that required manufacturers to disclose wholesale acquisition cost...
On July 9, the Fifth Circuit Court of Appeals will hold hearings on the constitutionality of the individual mandate in Texas v. Azar, the Kaiser Family Foundation (KFF) reports.
The hearing on Tuesday...
CMS is streamlining the Medicaid review process and making it more transparent, efficient, and less burdensome in an effort to speed up approval times for state programs.
“At CMS, we are making...
Eligibility, cost sharing, and the role of private health insurance will be among the primary concerns for policymakers if they choose to design a single-payer health insurance system in the US,...
New Jersey will move away from the federal insurance marketplace and transition to a state health insurance exchange in 2021, Governor Phil Murphy announced last week.
The Democratic governor...
Pennsylvania Attorney General Josh Shapiro has filed a petition in Commonwealth Court to modify the consent decrees that govern the relationship between UPMC and Highmark Health, two of western...
CMS has approved Arizona’s request to add a community engagement requirement to its section 1115 Medicaid demonstration project, called “Arizona Health Care Cost Containment System”...
CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace.
Continuing a...
The partial government shutdown will have no impact on Medicare and Medicaid at the federal level, CMS has stressed to industry observers.
The nation’s public payers will continue to operate as...
California Governor Gavin Newsom has announced a series of major executive actions and budget proposals to reduce prescription drug costs and move California closer to the goal of healthcare coverage...
Nine of the nation’s most influential payer organizations, including AHIP and the Blue Cross Blue Shield Association (BCBSA), have released a new set of guiding principles aimed at eliminating...
CMS has released new policies that purport to help states create “alternatives” to the Affordable Care Act (ACA) and improve health insurance options, according to CMS Administrator Seema...
CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates.
CMS developed the rule...
CMS has proposed a new rule that would audit premium subsidy eligibility for individual health plan beneficiaries and monitor premium assistance programs through the federal insurance exchanges.
The...
Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers.
Moda Health Plan, BlueCross...
CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.
In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM)...
CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers.
The...
