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Republicans Release Plan to Replace the Affordable Care Act

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It is well-known the the GOP base has attempted to repeal the Patient Protection and Affordable Care Act for years since its passage. However, the big question that everyone has always wondered is what the Republicans would replace the Affordable...

CMS Awards $22M for Cost Transparency Under Affordable Care Act

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced in a press release that $22 million of funds are available to help state regulators with issuer compliance according to consumer protections under the Affordable Care...

New Ruling in Medicare Shared Savings Program Changes Payment

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As previously reported, the Centers for Medicare & Medicaid Services (CMS) have finalized a ruling that changes how the Medicare Shared Savings Program operates its payment protocols among accountable care organizations. The change impacts...

How State Policymakers Impact the Health Insurance Mergers

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In the state of Missouri, policymakers issued an order that would prevent the Aetna-Humana acquisition from proceeding in post-merger activity within Missouri's Medicare Advantage plans as well as some commercial health plans. The two biggest...

Affordable Care Act Brought the Uninsured Rate to 9.1%

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The Patient Protection and Affordable Care Act has made a tremendous impact on healthcare coverage among Americans. An extra 20 million people now have healthcare access  do due to the health insurance exchanges. The Centers for Disease...

How the SMART Act Resolved Medicare Secondary Payer Issues

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The Centers for Medicare & Medicaid Services (CMS) has released its final rule detailing a timeline for the expansion of the Medicare Secondary Payer Web portal, which must meet the requirements of the Medicare IVIG Access and Strengthening...

Supreme Court Leaves Zubik v. Burwell Case to Lower Courts

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On Monday, the Supreme Court unanimously called for the lower courts to rule on the Zubik v. Burwell case and to find a compromise. This particular court case argues on whether employers, specifically religious nonprofit groups, should be required...

New Proposed MACRA Rule Renovates Information Technology Use

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The Department of Health & Human Services (HHS) has proposed new rules regarding the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) which will essentially remove the meaningful use program and move forward in advancing health information...

How CMCS Improved Managed Care in State Medicaid Programs

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Earlier this week, the Centers for Medicaid and CHIP Services (CMCS) finalized its ruling on the managed care Medicaid reimbursement regulations. Soon afterward, the National Association of Medicaid Directors (NAMD) released a statement regarding...

CMS Rule Renovates Coverage beyond ACA’s Medicaid Expansion

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The Medicaid program has greatly changed since the passage of the Obama administration’s Affordable Care Act. Most importantly, more than half of the states throughout the nation have implemented Medicaid expansion, which means that more...

Proposed Rule in Oklahoma Impacts Costs of Prescription Drugs

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In recent months, scandals associated with the costs of prescription drugs have made headlines. About seven out of 10 Americans are currently enrolled in a health insurance plan that covers costs of prescription drugs. Prescription drug plans...

Primary Care Payment Reform Targeted in Multi-Payer Initiative

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The Centers for Medicare & Medicaid Services (CMS) are renovating how primary care is delivered throughout the United States. According to a news release from the agency, CMS is launching a program called the Comprehensive Primary Care Plus...

How CMS Could Boost Operation of Accountable Care Organizations

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Accountable care organizations (ACOs) have become a more mainstream method for improving care coordination and the quality of medical services while providing an opportunity for reducing wasteful spending. For instance, St. John Health System’s...

How Medicaid Expansion Improves Behavioral Healthcare Access

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When the Patient Protection and Affordable Care Act was passed into law, it established that Medicaid expansion across all 50 states would take place. However, a Supreme Court ruling created a clause that allowed Medicaid expansion to be optional...

HHS Issues Medicare Coverage Expansion for Diabetes Prevention

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One of the most common chronic medical conditions found today is that of diabetes. Healthcare providers and payers need to work together to find ways that could help reduce the rates of diabetes nationwide. Recently, the Department of Health...

How One Health Payer Partnership Reduced Hospitalizations

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Recently, the health payer Blue Cross and Blue Shield of Illinois (BCBSIL) announced in a press release that it will be extending its partnership with the American Lung Association of the Upper Midwest over the next two years. The specific partnership...

More Part D Beneficiaries Gain Access to Cost-Sharing Pharmacies

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Healthcare access among Medicare and Medicaid beneficiaries remains a top priority for the Centers for Medicare & Medicaid Services (CMS). In 2015, CMS listened to the concerns of many beneficiaries and discovered that many do not have efficient...

Payers Bear Monetary Losses in Health Insurance Exchanges

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Several medical insurance companies have experienced losses and financial troubles within the federal and state health insurance exchanges. UnitedHealth Group, for example, has considered pulling out of the health insurance exchanges starting...

CMS Released Proposed Rule for Accountable Care Organizations

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule that would revise the formula used to analyze the performance of accountable care organizations participating in the Medicare Shared Savings Program....

AHA Claims Stark Law Harms Value-based Care Reimbursement

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The American Hospital Association (AHA) has encouraged Congress, specifically the House Committee on Ways and Means, to put an end to regulatory obstacles standing in the way of value-based care reimbursement. In a letter sent to Chairmen Brady,...

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