On August 14, the Federal Circuit court made two decisions affecting payers which centered around practices meant to lower costs for Affordable Care Act marketplace enrollees: government reimbursement...
Major payers and payer organizations objected to the finalized HHS nondiscrimination rule—Affordable Care Act Section 1557—saying that the rule eliminates much of the specific language in...
Better Medicare Alliance has followed up on its recommendations to CMS and HHS that take into account the uncertainties Medicare Advantage health plans currently face in making bid submissions for...
In an 8-1 decision, the Supreme Court has ruled that the federal government must pay $12 billion to insurers enrolled in the Affordable Care Act’s risk corridor program.
The risk corridor...
The US Court of Appeals dealt a blow to Medicaid work requirements when the judges presiding over Gresham v Azar upheld the lower court decision to invalidate Arknsas’s Medicaid work...
The HHS Transparency in Coverage proposed rule is not an actionable or secure method to achieving price transparency, nor is it an authorized exercise of HHS authority, AHIP argues in its comments on...
Update 1/13/20: This article has been updated to reflect that the American Academy of Actuaries’ paper and the Tenth Circuit Court decision were in regards to the Affordable Care Act’s...
The Tenth Circuit Court of Appeals determined that the rules HHS used to calculate 2014 through 2018 risk adjustments were neither arbitrary nor capricious.
In order to help healthcare payers predict...
A judge blocked a California bill, AB 290, that would prevent dialysis providers from encouraging end-stage renal disease (ESRD) patients to select health plans that some say offer dialysis providers...
Twenty-eight percent of the uninsured population could have enough premium tax credits to obtain zero-premium bronze-level health plans in 2020 due to silver-loading, a Kaiser Family Foundation (KFF)...
Twenty-three senators are concerned about the administration's promotion of short term, limited duration plans that may not meet the ACA’s coverage and pre-existing condition protection...
HHS and CMS are being sued over Michigan’s section 1115 demonstration waiver defining the state’s new work requirements.
The plaintiffs, who include individuals who would be impacted by...
Democrats from both the House of Representatives and the Senate sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema about reported technical problems that may have prevented 100,000...
While HHS celebrated the lowest Medicare fee-for-service improper payment rates in nearly ten years, eligibility complexities and fraud have racked up false payments in Medicaid and the...
HHS announced the Transparency in Coverage proposed rule requiring payers offering group and individual health insurance plans and employer-sponsored group health plans to offer price transparency...
According to a study by the Georgetown Center for Children and Families, the number of uninsured children has increased by over 400,000 in a two year time-span and policymakers and researchers alike...
The average premium on Healthcare.gov dropped for a second consecutive year, down by four percent, CMS announced.
Delaware saw the highest Healthcare.gov premium decline, where the premium for a...
By allowing the HHS to negotiate drug prices tied to international standards, Title I of the Lower Drug Costs Now Act of 2019 (HR-3) would save the federal government $345 billion from 2023 to 2029,...
Medicare Advantage plans with prescription drug coverage (MA-PD) star ratings demonstrate that these plans are flourishing in distribution and, most of all, quality, CMS announced when it released the...
Private payers and public payers alike have been working to assist states thrashed by Hurricane Dorian by driving care coordination and patient care access.
After HHS Secretary Alex Azar declared a...
