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’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...
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...
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,...
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...
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,...
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...
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...
Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.
A number of influential organizations have...
The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings...
The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces....
CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility. The approval...
Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the...
The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey.
In 2016, 12.2 percent of working...
CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare...
CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program.
The...
A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS...
CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would...
AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health...
CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider...
