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Physical Therapy, Chiropractic Back Care Cut Opioid Use, Costs

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Payers could improve outcomes, increase cost-effectiveness, and reduce opioid use for lower back pain by expanding non-pharmacological coverage such as physical therapy and chiropractic care, according to a new study published in JAMA...

CMS Broadens ACA Waiver Scope for State Insurance Programs

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CMS has issued federal guidance intended to expand the scope and availability of state-level waiver programs.   State governments can now apply for State Relief and Empowerment Waivers that may result in weaker consumer protections...

Medicare Advantage Plans Proliferate in 2019, Raising Competition

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Medicare Advantage (MA) payer competition is increasing significantly for plan year 2019 as more than 400 new options hit an already-crowded market, says a new report from the Kaiser Family Foundation (KFF).   More than 2700...

Insured Critical Illness Beneficiaries Face High Treatment Costs

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Health plan members with critical illnesses face high treatment costs and other financial issues even with comprehensive health insurance, said a new survey conducted by the Harvard T. Chan School of Public Health, New York Times, and...

Administrative Plan Costs for Managed Care Payers Jumped 5.7% in 2017

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Managed care payers experienced a 5.7 percent increase in administrative plan costs in 2017, for items such as staffing and customer service support, according to an analysis from the Sherlock Company. Spikes in Medicaid enrollment...

BCBS of TN Defrauded $2M in $2B Telemedicine Insurance Scheme

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BlueCross BlueShield (BCBS) of Tennessee has been named a damaged party after it was defrauded $2 million as part of a larger $2 billion telemedicine insurance scheme, according to the Department of Justice (DOJ). The District Court for...

Medicare Diabetes Prevention Program May Have Cost Concerns

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The Medicare Diabetes Prevention Program (MDPP) may not fully cover provider costs needed to administer classes and other programs to prevent diabetes among Medicare members, says a new report from the University of Colorado (UC) School of...

IL Payers File Pharma Lawsuit Over Opioid Prescription Costs, Safety

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A coalition of Illinois payers has sued prominent pharmaceutical companies in a lawsuit that argues the companies are responsible for a spike in opioid prescription costs and patient safety risks. The Intergovernmental Risk Management...

$36.9M in Medicare Fraud Leads to Federal Convictions, Sentencing

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New high-profile Medicare fraud cases have led to convictions and lengthy prison sentences for providers that attempted to defraud Medicare of $36.9 million. Federal agencies including HHS, the FBI, the Department of Justice (DoJ), and...

CMS Proposes Drug Price Transparency in Television Ads

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CMS has proposed a new rule that would enhance drug price transparency by requiring drug manufacturers to publish wholesale prices of Medicaid and Medicare prescription drugs during television ads. The proposed rule would require...

PA Expands Access to Medication Assisted Treatment for SUD

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Commercial payers and the Pennsylvania Department of Insurance (PDI) have agreed to increase access to medication-assisted treatments (MAT) and realign prior authorization processes for beneficiaries struggling with substance use disorders...

Medicare Deductibles, Premiums to Increase Slightly in 2019

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CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

Medicaid Beneficiaries Face Significant Food Insecurity Challenges

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Medicaid beneficiaries face significant food insecurity challenges and may require additional healthcare programs to reduce food insecurity risks, according to new research from the Root Cause Coalition. Many Medicaid beneficiaries...

CMS: ACA Premiums to Decline in 2019 for Silver Plan Consumers

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CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans. The agency stated that it is the first time since 2014 that premiums in any part of...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

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CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

AMA, Industry Orgs Object to Short-Term Health Plan Expansion

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The American Medical Association and other industry trade groups have filed amici curiae in support of a lawsuit contesting the legality of short-term health plans. The Association for Community Affiliated Plans (ACAP) contends that the...

CVS-Aetna Merger Gets DOJ Nod as Aetna Sheds Medicare Part D

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The Department of Justice (DOJ) has announced that it will approve the proposed merger between CVS and Aetna as soon as Aetna completes the divestiture of its Medicare Part D business line.   Two weeks ago, Aetna initiated the sale...

Spending, Prescription Histories Identify Future High Cost Members

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An individual’s healthcare spending and prescription drug histories are among the most accurate predictors of future high costs, according to a new Society of Actuaries (SOA) report. SOA used claims data collected by the Health Care...

Payers Partner with Trade Orgs to Roll Out Association Health Plans

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Healthcare payers are beginning to launch partnerships with trade organizations and chambers of commerce to provide association health plans (AHPs) to small businesses and contractors. The roll out of AHPs follows federal and state...

Private Insurance Spending Has Outpaced Public Spending Since 2016

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Private insurance spending has grown faster than Medicare and Medicaid spending since 2016, even though national enrollment has plateaued, says a new report from Altarum. The report suggests that higher per-enrollee spending, plus...

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