Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Regulation

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

September 22, 2017 - AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet the criteria of a sustainable solution for the industry.   “Throughout this debate, we have been committed to engage in a collaborative, constructive...


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Arkansas Slips Up on Supplemental Medicaid Payments

by Thomas Beaton

A lack of administrative oversight led Arkansas to miss supplemental Medicaid payments, make several payments to Medicaid-ineligible providers, and receive excess Medicaid dollars, found a report from the Office of the Inspector General (OIG)....

Governors Propose Health Insurance Market Stabilization Plan

by Thomas Beaton

Eight state governors have outlined their proposals for a health insurance market stabilization plan that would control premium increases and improve competition in the federal and state health insurance exchanges. In a letter sent to Congress,...

HHS to Spend $10M on Affordable Care Act Navigator Program

by Thomas Beaton

HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the Navigator...

20.5 Million More Insured Since Start of Affordable Care Act

by Thomas Beaton

20.5 million more individuals have gained health insurance coverage since the implementation of the Affordable Care Act (ACA) in 2010, according to a new report from the CDC and the National Center for Health Statistics (NCHS). In the first three...

Low Medicaid Payment Rates Decrease Residential Care Quality

by Thomas Beaton

Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

by Thomas Beaton

A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs, the group announced in a joint statement....

ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

by Jennifer Bresnick

In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with the individual mandate for insurance coverage...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

by Jennifer Bresnick

After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care Reconciliation Act, which included deep cuts to Medicaid...

Tiebreaker Vote in Senate Opens ACA Repeal, Replacement Debate

by Thomas Beaton

In a 50-50 procedural vote, Vice President Mike Pence broke the tie as the US Senate voted to open debate for a future vote on American Health Care Act (AHCA), and the possible addition of amendments to the bill. After failing to garner...

CMS: Reinsurance, Risk Adjustment Programs Worked Well in 2016

by Jesse Migneault

CMS has released the results from 2016 for reinsurance and risk adjustment transfers, two of the “three R’s” used to stabilize premiums in the Affordable Care Act (ACA) marketplaces.   This marks the third year the agency...

CBO Score Finds 22 Million People Will Lose Health Coverage

by Thomas Beaton

UPDATE: GOP Senators delayed the vote on the BCRA until after the July 4th congressional recess.  The Congressional Budget Office (CBO) released their revised cost estimate on the new ACA repeal bill, the Better Care and Reconciliation...

Senate Has Released Bill to Revise ACA Repeal Legislation

by Jesse Migneault

The Senate has released the working draft of the Better Care Reconciliation Act of 2017, revising the recently House-passed AHCA.   Both bills aim to repeal and replace the Affordable Care Act (ACA), which was passed in 2010. The AHCA...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

by Jesse Migneault

Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive surgeries. Medicare...

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

by Jesse Migneault

To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits the...

House Passes AHCA To Repeal and Replace ACA By 1 Vote Margin

by Jesse Migneault

The House has successfully passed the American Health Care Act (AHCA) to repeal-and-replace the ACA.  This was the House GOP’s second attempt to pass the bill, after the first vote was abruptly cancelled by Speaker Paul Ryan in...

Anthem Appeals Cigna Merger with Cost, Quality Arguments

by Thomas Beaton

Anthem has opened an appeal in the U.S District Court citing opportunities for increased consumer savings and quality of care weeks after the DOJ blocked its planned merger with Cigna. Anthem argued that the DoJ’s ruling neglected a possible...

Market Monopoly Cause of Court Blocking Cigna-Anthem Merger

by Thomas Beaton

The full opinion of United States District Court for the District of Columbia blocking Anthem’s acquisition of Cigna became publicly available earlier this week and provides details into the court’s decision. In the memorandum opinion,...

After Terminated Merger, Cigna Demands $13B from Anthem

by Thomas Beaton

UPDATE: Anthem has secured a restraining order against Cigna preventing the final dissolusion of the merger.  The temporary order will be reviewed during a Delaware Chancery Court hearing on April 10. After a court ruling ended the...

Aetna, Humana Terminate Merger Deal After Court Defeat

by Thomas Beaton

Aetna and Humana have scrapped their merger plans after the Department of Justice blocked the deal due to antitrust concerns.  Aetna will pay Humana a $1 billion termination fee, included as part of the original agreement. The DOJ lawsuit,...

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