Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Regulation

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

by Thomas Beaton

CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The...

Short-Term Health Plans Lack Mental Health, Prescription Benefits

by Thomas Beaton

Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser Family Foundation (KFF)...

CMS Aims to Catalyze Advancements in Consumer Price Transparency

by Thomas Beaton

A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS Administrator Seema Verma. Verma...

CMS Rule Ups Medicare Hospital Payments, Cuts Quality Measures

by Thomas Beaton

CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would also increase price transparency and...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

by Thomas Beaton

CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management,...

HHS Appoints James Parker to Address Health Insurance Costs

by Thomas Beaton

HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served...

DoJ Settles $27.68M in Medicare Fraud, False Claims Act Violations

by Thomas Beaton

The Department of Justice continues its crackdown on Medicare fraud by settling various criminal cases related to $27.68 million of False Claims Act violations. Provider settlements remain the primary medium for healthcare fraud...

Maryland Creates State Reinsurance Program to Control Premiums

by Thomas Beaton

Maryland governor Larry Hogan has signed legislation to create a state reinsurance program aimed at stabilizing health plan premium increases. The reinsurance program will use state and federal reinsurance funding to pay catastrophic...

CMS Relaxes Affordable Care Act Health Plan Regulations

by Thomas Beaton

CMS has issued a final rule that relaxes certain Affordable Care Act health plan regulations in an effort to drive competition and affordability within state health insurance markets. The agency said that the new rule will give payers...

CMS Final Rule Aims to Lower Medicare Prescription Drug Costs

by Thomas Beaton

CMS is planning to lower Medicare prescription drug costs through a final rule that allows members to purchase less expensive biosimilars and generic drugs and increases the potential value of Medicare Advantage (MA) and Part D plans. CMS...

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

by Thomas Beaton

CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from...

AL Medicaid Work Requirements Linked to Health Equity Challenges

by Thomas Beaton

Alabama’s proposed Medicaid work requirements are likely to lead to health equity challenges by inadvertently creating eligibility barriers for vulnerable populations, according to research from the Georgetown Health Policy...

Payers Will Face Individual Health Plan Market Challenges in 2019

by Thomas Beaton

Payers participating in the individual health plan market will face challenges in 2019 based on the planned expansion of association health plans (AHPs), increased competition, and changing provider negotiations, according to the Urban...

Proposed Legislation May Lower Individual Premiums by 40%

by Thomas Beaton

Senator Lamar Alexander (R-TN), Senator Susan Collins (R-ME), House Energy and Commerce Committee Chairman Greg Walden (R-OR) and Representative Ryan Costello (R-PA) have proposed legislation that aims to lower individual health plan...

Individual Insurance Premiums to Soar Without Policy Actions

by Thomas Beaton

Individual insurance premiums may rise between 12 and 32 percent nationally by 2019, with cumulative increases of 34 to 94 percent by 2021, according to new research conducted by health plan actuaries and experts at Harvard, UCLA, and UC...

CMS: Idaho Association Health Plan Expansion Violates ACA

by Thomas Beaton

CMS Administrator Seema Verma informed Idaho governor C.L. “Butch” Otter (R-ID) and state insurance officials that efforts to launch an expansion of association health plan (AHPs) sales violates the market protections...

AR Medicaid Demonstration Adds 9-Month Re-Enrollment Block

by Thomas Beaton

Arkansas received approval from CMS for a 1115 Medicaid demonstration that adds work requirements for Medicaid eligibility and adds a nine-month block on member re-enrollment if individuals don’t find work. Arkansas’...

BCBS Earned Positive ACA Health Plan Revenues in Uncertain Market

by Thomas Beaton

BlueCross BlueShield of North Carolina (BCBS of NC) earned positive ACA health plan revenues after years of financial losses, citing low medical claims and more available consumers after other payers exited the sale of plans through...

Latest Medicare Fraud Schemes Targeted $139.4M via Kickbacks

by Thomas Beaton

Three Medicare fraud schemes in recent weeks have targeted a total $139.4 million, which led the Department of Justice (DoJ) to seek multiple convictions and a combined 33 years in prison sentences. Each of the schemes involved the use of...

Value-Based Care Key to Bipartisan Healthcare System Reform

by Thomas Beaton

A group of five governors developed a bipartisan plan to reform the US healthcare system by using value-based care strategies such as quality reporting, insurance stabilization policies, and encouraging consumers to have a more proactive...

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...