Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Federal Regulation

GAO: Insufficient Data on Success of 1115 Medicaid Demonstrations

by Thomas Beaton

State and federal evaluations of 1115 Medicaid demonstrations have insufficient data to determine demonstration success because states tend report fragmented program results, according a new GAO report. Currently, there are thirty-four...

CMS Proposes 9-Month Extension of Short-Term Health Plans

by Thomas Beaton

CMS is proposing that consumers should be allowed to stay on short-term health plans, including association health plans, for twelve months at a time, despite the fact that these plans are generally non-compliant with the Affordable Care...

Idaho Prepares to Offer Association Health Plans to Consumers

by Thomas Beaton

Idaho will allow payers to offer association health plans (AHPs) that are not required to meet all of the consumer protections or benefits criteria included in the Affordable Care Act.   Governor C.L. “Butch” Otter...

2019 HHS Budget Aims for ACA Repeal, Public Payer Savings

by Thomas Beaton

The newly proposed HHS Budget for fiscal year (FY) 2019 says a repeal and replace of the Affordable Care Act (ACA) would save the government trillions, while restructuring Medicare and Medicaid could produce federal savings. The budget...

Modernizing Medicare Fee-for-Service Cost-Sharing Has Trade Offs

by Thomas Beaton

Medicare’s fee-for-service (FFS) cost-sharing design requires modernization to protect beneficiaries from catastrophic costs, but changing the current design may bring new financial concerns, a new GAO report found. In 2015,...

IN Medicaid Waiver Uses Work Requirements, Tobacco Penalties

by Thomas Beaton

Indiana is the second state to receive approval for a 1115 Medicaid demonstration that adds work requirements as a condition of beneficiary eligibility.  The demonstration also adds premium penalties for tobacco use as well as...

Lawmakers Propose HDHP Coverage for Chronic Disease Prevention

by Thomas Beaton

A new bill introduced into the House and Senate would allow high-deductible health plans (HDHPs) to provide chronic disease prevention services before a patient meets his or her deductible, which could help to accelerate a growing HDHP...

House Bill Retains Low-Quality Medicare Advantage Plans until 2027

by Thomas Beaton

Update on 2/12/2018: Presdient Trump signed the spending bill into effect on Feburary 9th, 2018 which funds the government for two years and extends quality deadlines for Medicare Advantage plans.  The latest government spending bill...

Medicare Fraud Cases Lead to Mix of Convictions, Settlements

by Thomas Beaton

The Department of Justice’s (DoJ) crackdown on Medicare fraud continued as new investigations led to one provider conviction and two multi-million dollar settlements with provider organizations. The conviction found a provider...

Academy of Actuaries Reaffirms Association Health Plan Risks

by Thomas Beaton

The American Academy of Actuaries released a statement reaffirming its concerns with expanding association health plan (AHPs) availability in light of perceived risks to the individual insurance marketplace. The statement precedes...

ACA Implementation Led to Varied Out-of-Pocket, Premium Spending

by Thomas Beaton

Affordable Care Act (ACA) implementation led to an 11.9-percent decrease in out-of-pocket spending but also a 12.1-percent increase in premium spending totals, according to a study published in JAMA Internal Medicine. The landmark...

VA, HHS Announce Healthcare Fraud Prevention Partnership

by Thomas Beaton

The Department of Veterans Affairs (VA), HHS, and CMS agreed to participate in a healthcare fraud prevention partnership that leverages data sharing to identify fraud and abuse within healthcare programs they collectively oversee. The...

Healthcare Orgs Commend Vote to Fund CHIP for 6 Years

by Thomas Beaton

A number of healthcare stakeholders and provider groups have praised bipartisan legislation that re-authorizes CHIP funding for the next six years. Democratic members of the House and Senate agreed to pass a stopgap government funding...

Aetna Agrees to $17M Settlement in HIV Privacy Data Breach

by Thomas Beaton

Aetna has agreed to pay $17,161,200 in a settlement involving allegations that the payer exposed private HIV information for more than 12,000 beneficiaries. The final terms of the settlement require Aetna to break up the total settlement...

AMGA: Align Quality, Performance across Medicare Advantage, ACOs

by Thomas Beaton

CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to...

Provider Health Insurance Fraud Schemes, Settlements Top $310M

by Thomas Beaton

Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

by Thomas Beaton

Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program...

VA Updates Emergency Care Reimbursement, Payment Activities

by Thomas Beaton

The VA has announced that it will expand provider payment eligibility for emergency treatment services and make  administrative and regulatory changes aimed at creating payment process improvements. The January 9th, 2018 rule extends...

CMS to Test Medicaid Waiver “Community Engagement” Incentives

by Thomas Beaton

CMS plans to support the addition of “community engagement” incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announced in a press release. The new policy...

IT Investment to Help VA Speed Claims Administration, Payment

by Thomas Beaton

The Department of Veterans Affairs (VA) has announced new goals for claims administration and a significant investment in health IT tools that will help coordinate payment for community providers. The VA has set the goal of increasing the...

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