North Carolina has received a 1115 waiver from CMS allowing the state to implement a Medicaid managed care system administered through private payers.
The state’s Department of Health and Human...
A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.
The International Pricing Index (IPI) will test if...
The Departments of Labor, Treasury, and HHS have proposed a new rule that would allow employers to directly reimburse employees’ care costs through health reimbursement arrangements (HRAs) as an...
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...
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...
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...
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,...
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...
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...
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...
Montana is moving ahead with the idea of creating a reinsurance program for the state’s health insurance market. The program may reduce premiums between 10 and 20 percent, said Governor...
A bipartisan group of Senators has introduced legislation that aims to end surprise healthcare billing, a practice which can lead to extremely high out-of-pocket costs for consumers.
The Protecting...
Medicare and Medicaid dual-eligible care models provide extensive care coordination to ensure beneficiaries with multiple chronic conditions can access healthcare services, according to a new AHIP...
FDA has launched a new quality assurance program that leverages feedback from commercial payers about medical device coverage requirements in order to expedite approvals.
The Private Payor Program...
The House Committee on Energy and Commerce has asked the Medicare Payment Advisory Commission (MedPAC) to investigate whether or not hospital consolidation increases Medicare spending.
In a letter to...
Consumers of dental plans may benefit from more transparency around the medical loss ratio (MLR) of dental insurance options, asserts the California Dental Association (CDA).
In a recent research...
Several states have announced lower ACA premium rates for 2019, bucking a national trend brought on by unstable markets and regulatory changes.
While early proposals from a number of states,...
Payer organizations are exercising their right to use the court system to collect cost sharing reduction (CSR) payments that were not provided in the last quarter of 2017.
A number of lawsuits are...
Maintaining a profitable individual health plan product is already challenging, but adverse selection can create additional problems that impede a payer’s ability to control health plan...
CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice.
A memo from the agency highlights a...