Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Regulation

Department of Labor Finalizes Association Health Plan Expansion

June 19, 2018 - The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes that allow consumers, employer groups, and contractors to sponsor AHPs, which may be more affordable but offer fewer consumer protections than plans compliant...


More Articles

US Court: Payers Are Responsible for Risk Corridor Program Costs

by Thomas Beaton

Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the majority...

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

by Thomas Beaton

BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of gains and...

Humana, Roche Diagnostics Face $45M Federal Kickback Lawsuit

by Thomas Beaton

Humana and Roche Diagnostics will face a $45 million federal kickback lawsuit after a whistleblower filed a False Claims Act violation, which alleges Roche tried to entice Humana financially to secure access to the payer’s business operations....

AHIP, Provider Groups Balk at DOJ Position on ACA Mandates

by Thomas Beaton

AHIP and a number of professional societies and provider groups are urging the Trump Administration to enforce key provisions of the the Affordable Care Act after the Department of Justice (DOJ) said it would not defend the ACA in a federal court...

Department of Justice Argues Against ACA Essential Health Benefits

by Thomas Beaton

The Department of Justice (DoJ) has argued against the Affordable Care Act’s essential health benefits (EHBs) and the law’s individual mandate by supporting a lawsuit that argues the constitutionality of both laws, Attorney General...

President Trump Signs Bill to Expand Privatization of VA Healthcare

by Thomas Beaton

President Trump signed the Veterans Affairs’ Mission Act into law midweek which will provide over $50 billion in federal investments to privatize a portion of the VA’s healthcare system and improve historical inefficiencies. The VA...

Medicare Bundled Payment Programs Primed to Produce Savings

by Thomas Beaton

Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from USC Brookings explains. CMS’s current...

Maine Court to Force Medicaid Expansion Past LePage’s Block

by Thomas Beaton

A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act (ACA). Justice Michaela...

ACA’s Individual Mandate Boosted High-Income Enrollment Totals

by Thomas Beaton

The Affordable Care Act’s (ACA) individual mandate spurred greater high-income enrollment in health plans and is a key component of increasing enrollment and stability in the nation’s individual insurance markets, according to a new...

CMS Medicaid Scorecards Increase Transparency, Accountability

by Thomas Beaton

CMS has released new Medicaid scorecards that contain care quality data on a state-by-state basis in order to improve transparency and accountability across the Medicaid program. CMS Administrator Seema Verma emphasized a need for increased access...

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

by Thomas Beaton

HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report found....

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have altered...

CMS: Medicare Part D Gag Clauses are “Unacceptable”

by Thomas Beaton

CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug price transparency for beneficiaries. “We...

Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

by Thomas Beaton

The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently targeted...

CMS Highlights Drug Price Transparency Data Dashboards

by Thomas Beaton

CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore data...

MD Extends All-Payer Model, Targets $1B in Medicare Savings

by Thomas Beaton

Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from Hogan’s...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

by Thomas Beaton

Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including some...

CMS Approves Medicaid Work Requirements in New Hampshire

by Thomas Beaton

CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility.  The approval makes New Hampshire the fourth state to integrate...

Verma: Patient Care, Payment Design Need Value-Based Reforms

by Thomas Beaton

Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA). During the...

X

Sign up for our free newsletter:

Our privacy policy

no, thanks