Policy and Regulation News

Payers react to 2025 Medicare Advantage, Part D Final Rates

April 10, 2024 - Payer trade organizations responded negatively to the 2025 Medicare Advantage and Part D Final Rate Notice, citing rising healthcare costs. “The CMS Final Rate Notice failed to address the concerns of influential bipartisan Members of Congress, thousands of Medicare Advantage beneficiaries, and more than one hundred organizations serving...

Read More


Articles

CMS chops short-term, limited duration plan length to 4 months

by

The Biden administration has reduced the timeframe of short-term limited duration insurance plans, also known as “STLDI” or “junk” plans, in an effort to curb underinsurance,...

Hospital Outpatient Department Costs Consistently Outpace Offices, ASCs

by

Given the significant difference between cost of care in hospital outpatient department settings compared to other settings for the same services, site-neutral payments could reduce healthcare...

Medicare Part D Patients with HIV May See Lower Drug Costs Under IRA

by

The Inflation Reduction Act’s Medicare Part D redesign may improve affordability for beneficiaries with HIV, but stakeholders will need to take steps to ensure beneficiaries get the most out of...

OIG Strengthens Oversight Strategy for Managed Care Organizations

by

Managed care organizations (MCOs) require the same kind of oversight that fee-for-service programs receive from the Office of Inspector General (OIG), so OIG released a four-phase life cycle to align...

Payers, Employers Support the No Surprises Act IDR Process in Court

by

The provisions of the No Surprises Act rule that detail the independent dispute resolution (IDR) process for out-of-network claims have been making waves in the healthcare space. The No Surprises Act...

AHIP, BCBSA Voice Concerns About Proposed Prior Authorization Rule

by

AHIP joined the American Hospital Association (AHA), American Medical Association (AMA), and Blue Cross Blue Shield Association (BCBSA) in opposing the prior authorization reformation efforts from CMS...

VA Benefit Unawareness Leaves Vets Vulnerable to Healthcare Fraud

by

Veterans’ lack of awareness about their potential benefits under the Promise to Address Comprehensive Toxics Act (PACT Act) could lead to significant financial losses due to healthcare...

Biden Admin Proposes Mental Health Parity in Private Health Plans

by

The Biden-Harris Administration has proposed a rule to improve access to mental healthcare for privately insured Americans by establishing mental health parity requirements. The rule supports the...

Generic Insulin Drug Pricing, Access Still Pose Problems for Uninsured

by

Following up on a promise that Eli Lilly made in 2019, the offices of Senators Elizabeth Warren (D-MA), Richard Blumenthal (D-CT), and Raphael Warnock (D-GA) conducted a survey on the drug pricing and...

HHS Proposed Rule Aims to Distinguish STLDI from Comprehensive Plans

by

The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury have released a notice of proposed rulemaking that applies to short-term, limited-duration...

Employer Sponsored Health Plan Enrollment Will Hit 159M in 2033

by

Employer-sponsored health plan enrollment among nonelderly Americans will grow after 2025, accompanied by higher private payer premiums, a Health Affairs study found. The study used Congressional...

Health Plans Must Continue Covering Preventive Care Services

by

A federal appeals court approved an agreement between parties in Braidwood Management v Becerra, preserving the mandate requiring health plans to cover preventive care services based on recommendations...

AHIP Urges 4 Types of Policies to Reduce Healthcare Spending

by

AHIP offered four recommendations to the Senate Finance Committee on Consolidation and Competition (the Committee) to support healthy competition and lower healthcare spending in the healthcare...

4 Categories of Preventive Care Services Covered Under the ACA

by

There are four types of services that private payers and employers are required to cover under the Affordable Care Act (ACA) preventive care services provision, which include screenings and...

Court Upholds ACA Preventive Care Compliance Amid Legal Proceedings

by

The US Court of Appeals for the Fifth Circuit determined that employers and health insurers must maintain compliance with Affordable Care Act (ACA) preventive care services provision while the law...

Uninsured Immigrants Face Significant Regulatory Barriers to Coverage

by

Regulatory barriers present significant hurdles for uninsured immigrants seeking healthcare coverage, a report from the Urban Institute and the Robert Wood Johnson Foundation (RWJF) found. The...

AHIP Marketing Campaign Targets Pharma’s Prescription Drug Pricing

by

AHIP has launched a marketing campaign targeting pharmaceutical companies and the role of prescription drug pricing in healthcare spending. “Let’s be clear, Big Pharma continues to...

Public-Private Program Boosts Uninsured Access to COVID-19 Vaccines

by

In an effort to maintain access to coronavirus vaccines for uninsured Americans, HHS has introduced a public-private partnership with pharmaceutical companies. The partnership, known as the “HHS...

Experts Assess the Effects of the No Surprises Act on Surprise Billing

by

The No Surprises Act may have successfully defended consumers from surprise billing but requires reworking in other areas, an issue brief from Urban Institute and the Robert Wood Johnson Foundation...

Recent Articles