Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Policy

Emergency Physician Group Sues Anthem for ED Payment Policies

July 18, 2018 - The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed a lawsuit against Anthem BCBS of Georgia contesting an emergency department payment policy that makes patients responsible for covering non-emergency expenses. The lawsuit, filed in the District Court of Northern Georgia, contends that Anthem’s policy to retroactively deny...


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All-Payers Claims Databases May Increase Healthcare Price Transparency

by Thomas Beaton

Leveraging the data of all-payers claims databases (APCDs) could improve healthcare price transparency for consumers, according to testimony presented at a House Energy and Commerce Committee hearing. Jamie S. King, a professor at the USC H...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare

by Thomas Beaton

CMS has proposed a series of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As part...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Cuts ACA Navigator Funding Grants by $26M for 2019

by Thomas Beaton

CMS has announced a $26 million cut to funding grants for ACA navigators, from $36 million down to $10 million. CMS will provide a minimum of $100,000 in each of the states that operate a federally-facilitated exchange (FFE). The funding wi...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

by Thomas Beaton

CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct state-to-pro...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Transitional Health Insurance Plays Key Role in Coverage

by Thomas Beaton

Transitional health insurance, otherwise known as a short-term health plan, is a temporary insurance policy intended to provide stop-gap coverage when an individual is in between ACA compliant policies.  The National Association of Ins...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Vermont Government Plans Regulations for Association Health Plans

by Thomas Beaton

Vermont’s Department of Financial Regulation (DFR) is planning to implement emergency rules and regulations for association health plans (AHPs) following the Department of Labor’s final rule to allow AHP sales nationally. DFR sa...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS: Individual Health Plan, Federal Exchange Challenges Remain

by Thomas Beaton

CMS has released three new reports indicating that the individual health plan and federal exchange markets faltered somewhat in 2017 because of increasing premiums, decreasing competition, and stagnant enrollment. The agency believes that t...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

by Thomas Beaton

HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2 b...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Federal Court Strikes KY 1115 Medicaid Waiver Work Requirements

by Thomas Beaton

The US District Court for the District of Columbia has blocked Kentucky from implementing work requirements within its 1115 Medicaid waiver demonstration, despite CMS approval of the community engagement provisions. The court ruled that add...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

by Thomas Beaton

Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and determined ...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS to Develop New Medicaid Program Integrity Initiatives

by Thomas Beaton

CMS has announced a new set of Medicaid program integrity initiatives that leverage enhanced data sharing, claims auditing, and provider education to reduce the incidence of improper payments and help secure program finances. In 2016, Medic...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Senators: Stop $89B in Medicare, Medicaid Improper Payments

by Thomas Beaton

The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid. The Senators referenced a recent GAO report suggeste...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Department of Labor Finalizes Association Health Plan Expansion

by Thomas Beaton

The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes th...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

US Court: Payers Are Responsible for Risk Corridor Program Costs

by Thomas Beaton

Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the majorit...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

BlueCross BlueShield Nets $2.3B in Savings from 2017 Tax Cuts

by Thomas Beaton

BlueCross BlueShield companies saw  a total tax savings of $2.3 billion after passage of last year’s Tax Cuts and Jobs Act (TCJA), according to a new creditor’s briefing from AM Best. BCBS companies reported a mix of gains ...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

AHIP, Provider Groups Balk at DOJ Position on ACA Mandates

by Thomas Beaton

AHIP and a number of professional societies and provider groups are urging the Trump Administration to enforce key provisions of the the Affordable Care Act after the Department of Justice (DOJ) said it would not defend the ACA in a federal...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

by Thomas Beaton

CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome (NAS)...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Department of Justice Argues Against ACA Essential Health Benefits

by Thomas Beaton

The Department of Justice (DoJ) has argued against the Affordable Care Act’s essential health benefits (EHBs) and the law’s individual mandate by supporting a lawsuit that argues the constitutionality of both laws, Attorney...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

President Trump Signs Bill to Expand Privatization of VA Healthcare

by Thomas Beaton

President Trump signed the Veterans Affairs’ Mission Act into law midweek which will provide over $50 billion in federal investments to privatize a portion of the VA’s healthcare system and improve historical inefficiencies. The...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

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