Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Reform

GAO: Medicaid Home, Community Care Create Financial Conflicts

January 17, 2018 - Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local agencies, and managed care plans, may over or underestimate financial resources to support HCBS programs, leading to inappropriate Medicaid spending. HCBS program...


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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 demonstration...

How Payers Can Build a Successful Bundled Payment Strategy

by Thomas Beaton

Bundled payment models are a popular reimbursement option for payers because they present an opportunity to improve healthcare quality, lower costs, and participate in value-based agreements with limited financial risk.   However, if payers...

Proposed Rule Details Association Health Plan Expansion Guidelines

by Thomas Beaton

The Department of Labor (DoL) released a proposed rule that allows small businesses and employee groups to purchase association health plans (AHPs) in lieu of employer-sponsored or individual health insurance. The rule follows an executive order...

Affordable Care Act Changes May Bring a Rocky 2018 for Payers

by Thomas Beaton

2017 was a turbulent year for the Affordable Care Act.  Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an uncertain future. Even though Congress has not...

MS Awarded 10-Year Extension of 1115 State Medicaid Waiver

by Thomas Beaton

Mississippi will be the first state to receive a 10-year extension of a 1115 Medicaid waiver, CMS announced.  The waiver originally implemented in 2003, expands eligibility requirements for individuals who can receive family planning benefits....

MI Requests Renewal of “Healthy Behaviors” 1115 Medicaid Waiver

by Thomas Beaton

Michigan is asking CMS for a renewal of its 1115 Medicaid waiver demonstration that increased the number of insured individuals in the state and led to a reduction in unhealthy behaviors. The demonstration, entitled the “Healthy Michigan...

2018 ACA Open Enrollment Totaled 8.82M Beneficiaries in Last Week

by Thomas Beaton

Approximately 8.82 million beneficiaries enrolled in a health plan during the seven week 2018 ACA open enrollment period, which experienced surges in health plan purchasing activity during the final two weeks. The opening week of 2018 open...

Federal Tax Bill, Individual Mandate Repeal Passes House and Senate

by Thomas Beaton

GOP lawmakers in both the House and Senate passed a federal tax bill that includes a repeal of the ACA’s individual mandate to purchase health insurance.  The bill now heads back to the House for a procedural vote and afterwards to...

AHIP, BCBS: Association Health Plan Expansion Presents Concerns

by Thomas Beaton

An October executive order that expands the availability of short-term association health plans (AHPs) could present significant challenges for state governments and consumers, asserted AHIP, BCBS, and a number of other payer organizations in...

State Medicaid 1115 Waivers Expand Eligibility, Stabilize Premiums

by Thomas Beaton

A number of state governments have submitted Medicaid 1115 waivers to CMS in order to expand Medicaid eligibility requirements, stabilize their in-state premium rates, manage public health issues, and improve behavioral health access. Currently,...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

by Thomas Beaton

At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the pharmaceutical...

Individual Mandate Repeal Would Lead to Payer Financial Losses

by Thomas Beaton

A repeal of the individual mandate, as included in the current GOP Senate tax reform plan, would result in financial losses for payers that could not be offset by cost-sharing reduction payments, the Academy of American Actuaries says.  ...

Prescription Drug Spending Cuts Require Payer Policy Changes

by Thomas Beaton

The US’s current prescription drug policies require updates that cut prescription drug spending while increasing competition in the market, a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found. A...

Senate Passes Tax Bill, Individual Mandate Repeal in 51-49 Vote

by Thomas Beaton

The US Senate voted 51-49 to reform national tax policy and simultaneously repeal the Affordable Care Act’s individual mandate, major news outlets reported at the end of last week. GOP senators only lost one Republican vote and were able...

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

by Thomas Beaton

As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In an...

Maine Referendum Expands Medicaid Despite Governor Opposition

by Thomas Beaton

The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

by Thomas Beaton

Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by Thomas Beaton

Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty resulting...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

by Thomas Beaton

The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the Congressional...

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