Policy and Regulation

Surprise Billing Law Covers Contract Disputes, Price Transparency

by Kelsey Waddill

Congress has passed a new law that seeks to eliminate surprise billing, particularly surprise bills that result from contract disputes, inaccurate provider directories, and air ambulatory...

Congress Repeals Anti-Trust Exemptions Over AHIP Objections

by Kelsey Waddill

Both houses of Congress have voted to repeal an anti-trust exemption in the McCarran-Ferguson Act of 1945 which protects payers from federal competition laws. The Competitive Health Insurance Reform...

What Payers Need to Know About 2020 Medicaid Managed Care Changes

by Kelsey Waddill

New CMS regulations around Medicaid managed care include several major changes regarding network adequacy, beneficiary protection, quality, and payment, according to the Kaiser Family Foundation...

Supreme Court Hears Case on Affordable Care Act Constitutionality

by Kelsey Waddill

At 10am EST on November 10, the Supreme Court heard the oral arguments in the California v Texas regarding the Affordable Care Act’s constitutionality. The case is pivotal as the outcomes could...

Court Affirms CSR Reimbursement, But Amount Still Questionable

by Kelsey Waddill

On August 14, the Federal Circuit court made two decisions affecting payers which centered around practices meant to lower costs for Affordable Care Act marketplace enrollees: government reimbursement...

Major Payers Find HHS Finalized Nondiscrimination Rule Too Narrow

by Kelsey Waddill

Major payers and payer organizations objected to the finalized HHS nondiscrimination rule—Affordable Care Act Section 1557—saying that the rule eliminates much of the specific language in...

IRS Creates Cafeteria Plan, HDHP Flexibilities Due to COVID-19

by Kelsey Waddill

The Internal Revenue Service (IRS) has issued guidance extending flexibilities to high deductible health plan (HDHP), employer-sponsored cafeteria plan, and flexible spending arrangement (FSA) plan...

Payers Slated to Pay $2.7B in Medical Loss Ratio Rebates in 2020

by Jacqueline LaPointe

Private payers could issue a total of $2.7 billion in medical loss ratio rebates in 2020, more than double the previous year’s record high of $1.4 billion, according to estimates from the Kaiser...

Supreme Court Rules Federal Government Must Pay $12B to ACA Insurers

by Jessica Kent

In an 8-1 decision, the Supreme Court has ruled that the federal government must pay $12 billion to insurers enrolled in the Affordable Care Act’s risk corridor program. The risk corridor...

Centene Program Helps Providers with Grant Writing, Business Loans

by Jessica Kent

Centene has created a support program to assist its network providers with grant writing, small business loan applications, and other key activities. For more coronavirus updates, visit...

What The Families First Coronavirus Response Act Means for Payers

by Kelsey Waddill

The Families First Coronavirus Response Act, the second relief package for the coronavirus pandemic, passed on March 18 with an overwhelming majority in the House and Senate. The act extends...

Volatility Drives Payer Technological Innovation, Partnerships

by Kelsey Waddill

Best’s Special Report, which HealthPayerIntelligence obtained by email, has discovered that healthcare payer technological innovations and partnerships often thrive under change and urgency,...

How Will Health Literacy Affect Interoperability Rule Benefits?

by Kelsey Waddill

With its new interoperability rule, CMS pushed ahead with the anticipated mandates, which direct payers to provide Patient Access application programming interfaces (APIs) and Provider Directory APIs,...

CMS Releases Finalized Rule on Interoperability

by Kelsey Waddill

CMS has released the next phase of the 21st Century Cures Act on interoperability. The rule, which was expected to be announced at HIMSS20 before the conference was canceled, supports the...

SCOTUS Will Review ACA Constitutionality, Decision Expected 2021

by Kelsey Waddill

Update 03/03/2020: This article has been updated to include a statement from America’s Health Insurance Plans (AHIP) on the Supreme Court’s decision to review the case. The Supreme...

Individual Mandate Void, ACA Constitutionality Still In Question

by Kelsey Waddill

The Fifth Circuit Court found the individual mandate to be unconstitutional but sidestepped making a decision on the rest of the Affordable Care Act (ACA). “The law has been a focal point of our...

Reinsurance Programs Reduce Individual Market Premiums by 16.9%

by Samantha McGrail

Reinsurance programs reduced premiums by 16.9 percent, on average, in the first year of program enactment relative to estimated premiums without reinsurance, according to a continuing Avalere analysis....

Verma Testifies to House on ACA Repeal, ACA Replacement Unknown

by Kelsey Waddill

When the House Committee on Energy and Commerce brought in CMS Administrator Seema Verma to testify regarding the White House’s attempts to repeal the Affordable Care Act, the hearing covered...

Premium-Cutting CO Public Option Plan Sparks Payer Concerns

by Kelsey Waddill

Colorado officials said that the state’s public option plan would save Coloradans 9 to 18 percent or more on monthly premiums, but payers and providers have concerns. The state released a draft...

Five Policies to Ensure Medicare Enrollees’ Access to Dental Care

by Kelsey Waddill

To resolve the lack of dental health plan coverage available for Medicare enrollees, the Kaiser Family Foundation (KFF) outlined five ways to improve seniors’ dental health plan...