Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Reform

All-Payers Claims Databases May Increase Healthcare Price Transparency

July 18, 2018 - 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 Hastings College of Law, told the committee that APCDs could address price transparency challenges if stakeholders use the millions of claims within...


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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}

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}

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}

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}

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}

Unstable Future Predicted for Medicare, Depletion by 2026

by Thomas Beaton

The Medicare Board of Trustees (MBT)’s latest report anticipates that Medicare’s Hospital Insurance (HI) Trust Fund will deplete by the year 2026 as Medicare spending continues to outgrow the trust’s collective revenues. T...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Maine Court to Force Medicaid Expansion Past LePage’s Block

by Thomas Beaton

A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act (ACA). Justice...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

ACA’s Individual Mandate Boosted High-Income Enrollment Totals

by Thomas Beaton

The Affordable Care Act’s (ACA) individual mandate spurred greater high-income enrollment in health plans and is a key component of increasing enrollment and stability in the nation’s individual insurance markets, according to a...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS Medicaid Scorecards Increase Transparency, Accountability

by Thomas Beaton

CMS has released new Medicaid scorecards that contain care quality data on a state-by-state basis in order to improve transparency and accountability across the Medicaid program. CMS Administrator Seema Verma emphasized a need for increased...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Early Health Insurance Premium Proposals Indicate Hikes for 2019

by Thomas Beaton

Significant increases to health insurance premiums are on the horizon for beneficiaries in multiple states as payers begin to share their 2019 rate plans.   A challenging regulatory landscape, complicated by policy changes that have al...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Virginia Legislature Approves Medicaid Expansion

by Thomas Beaton

The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid under ...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

GAO Appoints Public Policy, Payment Experts to MedPAC

by Thomas Beaton

The Government Accountability Office (GAO) has appointed five new public policy and healthcare payment experts to the Medicare Payment Advisory Commission (MedPAC). GAO chief Gene L. Dodaro, Comptroller General of the United States, is conf...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

MN Law Allows Some Patients to Override Payers on Step Therapy

by Thomas Beaton

Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to byp...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

CMS: Medicare Part D Gag Clauses are “Unacceptable”

by Thomas Beaton

CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug price transparency for beneficiaries. &ld...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

by Thomas Beaton

Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including so...{copy_healthpi}{content}{/copy_healthpi}{/article_body_blocks}

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