Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Regulation

Reinsurance Changes Payers Can Expect Under the ACA in 2018

by Thomas Beaton

ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

by Thomas Beaton

The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the...

Alexander-Murray Bill Offers ACA Market Stabilization, Flexibilities

by Thomas Beaton

A new bipartisan bill proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) is an attempt to stabilize and protect provisions of the ACA while allowing for greater state flexibility to manage healthcare. The Bipartisan...

Iowa Withdraws 1332 Waiver for Insurance Market Stabilization

by Thomas Beaton

Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.   The proposed stopgap measure  included a single, standardized plan available to...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

by Thomas Beaton

Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

by Thomas Beaton

Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many...

Payers Express Concern Following Cost-Sharing Reduction Cuts

by Thomas Beaton

Several payer organizations have expressed deep concerns after President Trump announced plans to end the cost-sharing reduction (CSR) subsidies for ACA individual plans. Organizations including AHIP, AMA, and AHA have previously urged...

Executive Order Eases ACA Rules on Association Health Plans

by Thomas Beaton

An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple...

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

by Thomas Beaton

Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office...

Senate to Vote on Funding CHIP for Five Additional Years

by Thomas Beaton

A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

by Thomas Beaton

HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal...

Medicaid Drug Pricing Rule May Inhibit Value-Based Contracts

by Thomas Beaton

A Medicaid drug pricing rule which safeguards deep discounts for the public program can potentially inhibit value-based contracts agreements between payers and pharmaceutical companies, according to research from the Journal of Health...

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

by Thomas Beaton

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...

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...

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...

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...

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...

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...

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...

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