Policy and Regulation News

New CMS Guidance Could Increase COVID-19 Testing Rates, Spending

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Since the Biden administration has eliminated the ability to deny coronavirus testing claims due to “medical necessity,” payers should expect higher coronavirus testing rates across all...

How the $1.9T COVID-19 Relief Package Impacts Medicaid, CHIP

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Congress passed a $1.9 trillion relief package to support the nation’s coronavirus pandemic response efforts and the law could have particular significance for Medicaid and CHIP programs. The...

CMS Puts $2.3M Toward Navigator Funding for Special Enrollment

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CMS will be offering $2.3 million in additional navigator funding for grantees in light of the special enrollment period, the agency announced by email. “President Biden has made clear that...

Cost Could Still Be A Deterrent In ACA Special Enrollment Period

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The special enrollment period on the Affordable Care Act marketplace opened to boost healthcare coverage during the coronavirus pandemic, but familiar barriers—namely, cost—could still...

AHIP: Medicaid Managed Care Orgs Deserve Greater SDOH Flexibility

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Given the positive social determinants of health impacts that Medicaid managed care organizations have achieved in Medicaid programs, policymakers should offer them greater flexibility to maximize that...

How Expanding ACA Premium Tax Credits Could Effect ESI Coverage

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Opponents of expanding the Affordable Care Act’s premium tax credit policy have argued that doing so would have a negative effect on employer-sponsored insurance, but recent research from the...

Payer Orgs Outline Steps Toward Achieving Universal Coverage

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All Americans should have healthcare coverage and six steps can make universal coverage a reality, according to several significant healthcare organizations and entities including America’s...

CMS Moves to Rescind Medicaid Work Requirements As Anticipated

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The Biden administration has reversed CMS policy on Medicaid work requirements, according to letters the agency sent to multiple Medicaid programs. In a letter to Wisconsin’s Medicaid director...

DOJ Supports the Affordable Care Act in Supreme Court Case

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The Department of Justice has backed down from its opposition to the Affordable Care Act, a letter from the Department of Justice to the Supreme Court announced. “Following the change in...

Humana, Roche Settle False Claims Act Lawsuit, Agree to Pay $12.5M

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An Anti-Kickback and False Claims Act lawsuit against Humana and Roche Diagnostics Corp. and Roche Diabetes Care, Inc. (Roche) has finally come to a close, Sanford Heisler Sharp, LLP announced. The...

Downstream Impacts of Recent Surprise Billing Law Remain Uncertain

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The impacts related to the No Surprises Act—which Congress included in the Consolidated Appropriations Act in order to address surprise billing—remain unclear, a Kaiser Family Foundation...

AHIP, ACAP Call for Reversals on Prior Administration’s Policies

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Major payer organizations, specifically America’s Health Insurance Plans (AHIP) and the Association for Community Health Plans (ACAP), are calling for a reversal on key Trump healthcare...

How Biden’s Executive Order May Impact Medicaid, ACA Marketplaces

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The recent executive order from the Biden administration represented a reversal in US healthcare policy that could have major implications for Medicaid and the Affordable Care Act...

Biden Administration Plans to Expand COBRA, ACA Premium Subsidies

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The Biden Administration’s coronavirus relief plan seeks to expand healthcare coverage during the pandemic by increasing and extending COBRA and Affordable Care Act premium subsidies and...

CMS 2022 Final Rule Requires Part D Real-Time Drug Benefits Tool

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CMS has released its final rule for Contract Year 2022 Medicare Advantage and Part D which requires Part D plans to offer a real-time benefits comparison tool. The agency estimated that the...

CMS Rule Aims to Accelerate Medicare Coverage of Breakthrough Tech

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CMS has issued a final rule entitled Medicare Coverage of Innovative Technology (MCIT) that aims to accelerate Medicare coverage of technological innovations. “Government processes have slowed...

Surprise Billing Law Covers Contract Disputes, Price Transparency

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Congress has passed a new law that seeks to eliminate surprise billing, particularly surprise bills that result from contract disputes, inaccurate provider directories, and air ambulatory...

CARES Act Funding Not Enough for Orgs in Medically Underserved Areas

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Medically underserved areas of the country received higher payments from The Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund. But these funds are likely insufficient for...

Congress Repeals Anti-Trust Exemptions Over AHIP Objections

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Both houses of Congress have voted to repeal an anti-trust exemption in the McCarran-Ferguson Act of 1945 which protects payers from federal competition laws. The Competitive Health Insurance Reform...

What Final Medicaid Value-Based Purchasing Rule Means for Payers

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CMS has finalized a rule which promotes private payers and states negotiating value-based purchasing contracts for Medicaid drugs, along with other changes. The final rule was built upon the Medicaid...