CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.
In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM)...
CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers.
The...
Alternative payment models (APMs) may be placing significant burdens and stress on physicians, requiring payers to make additional efforts to improve their communication and smooth the process of...
North Carolina has received a 1115 waiver from CMS allowing the state to implement a Medicaid managed care system administered through private payers.
The state’s Department of Health and Human...
A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.
The International Pricing Index (IPI) will test if...
CMS has issued federal guidance intended to expand the scope and availability of state-level waiver programs.
State governments can now apply for State Relief and Empowerment Waivers that may...
CMS has proposed a new rule that would enhance drug price transparency by requiring drug manufacturers to publish wholesale prices of Medicaid and Medicare prescription drugs during television...
CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans.
The agency stated that it is the first time...
The American Medical Association and other industry trade groups have filed amici curiae in support of a lawsuit contesting the legality of short-term health plans.
The Association for Community...
Montana is moving ahead with the idea of creating a reinsurance program for the state’s health insurance market. The program may reduce premiums between 10 and 20 percent, said Governor...
Investment in high-performance narrow networks, creating new payment incentives, and leveraging digital innovation could help to increase adoption of value-based payment reform across the healthcare...
A bipartisan group of Senators has introduced legislation that aims to end surprise healthcare billing, a practice which can lead to extremely high out-of-pocket costs for consumers.
The Protecting...
The House Committee on Energy and Commerce has asked the Medicare Payment Advisory Commission (MedPAC) to investigate whether or not hospital consolidation increases Medicare spending.
In a letter to...
Consumers of dental plans may benefit from more transparency around the medical loss ratio (MLR) of dental insurance options, asserts the California Dental Association (CDA).
In a recent research...
Several states have announced lower ACA premium rates for 2019, bucking a national trend brought on by unstable markets and regulatory changes.
While early proposals from a number of states,...
Payer organizations are exercising their right to use the court system to collect cost sharing reduction (CSR) payments that were not provided in the last quarter of 2017.
A number of lawsuits are...
CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice.
A memo from the agency highlights a...
The Affordable Care Act’s health insurance tax (HIT) is expected to levy $16 billion in fees for health insurers by 2020, leading payers to increase premiums by an anticipated 2.2 percent,...
The challenges of lowering care costs and improving healthcare quality may lead payers to consider the use of capitated payments as part of their value-based payment model strategies.
Capitated...
Next Generation Accountable Care Organizations (ACO) saved the Medicare program $62 million during their first year of operation in 2016, encouraging CMS to expand downside risk models across...
