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Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

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Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332 waiver...

Executive Order Eases ACA Rules on Association Health Plans

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An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple news...

CMS Releases 2018 Medicare Advantage Star Ratings for Health Plans

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CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.   The star ratings are based on several consumer engagement and care quality criteria,...

Senate to Vote on Funding CHIP for Five Additional Years

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A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance Dependable...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

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HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal Register....

Blue Shield of CA to Offer Statewide Healthcare Provider Directory

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Blue Shield of California plans to develop a statewide healthcare provider directory, with the help of Integrated Healthcare Association (IHA), that gives members access to current information on providers, the payer announced in a press release....

NB and IA Offer New Individual Market Plan For Open Enrollment

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An new individual market plan created out of Medica and CHI Health will be available to consumers during the open enrollment period in Nebraska and Iowa, the health networks announced in a press release. The Medica with CHI Health plan offers...

Nevada Blue to Offer Supplemental Medicare Coverage to Members

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On October 1, Blue Cross Blue Shield (BCBS) of Nevada members can enroll in Medicare Supplemental Innovation Plans F, G, or N that provide preventative care services and extended benefits, the payer announced earlier this week. The plans will...

Anthem to Acquire FL Medicare Advantage Organization HealthSun

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Anthem entered into an agreement to acquire Florida-based HealthSun, a payer and integrated health system that provides care and coverage to 40,000 Medicare Advantage beneficiaries, the payer announced in a press release.   Leaders at Anthem...

HHS to Spend $10M on Affordable Care Act Navigator Program

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HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the Navigator...

MS Medicaid Recovers $8.6M in Fraud, Improper Payments

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The Mississippi Division of Medicaid (DOM) recovered $8.6 million dollars from claims that were either directly fraudulent or improperly filed, the DOM announced in a press release. Through collaboration between Medicaid Fraud Control Units (MFCUs)...

As ACA Debate Lingers, Non-Marketplace Members Present Risks

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While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and wealthier,...

Payers May Be Neglecting a Growing Medicare Advantage Market

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Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

BCBS Minnesota Launches Prediabetes Prevention Campaign

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Blue Cross Blue Shield (BCBS) of Minnesota is launching a prediabetes prevention campaign to lessen the rate of diabetes in local communities, the payer announced in a press release. Titled “Reverse It,” the campaign focuses on helping individuals...

Boston Children’s, Cleveland Clinic Partner for Pediatric Care

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Boston Children’s Hospital and Cleveland Clinic have announced a partnership to provide complex pediatric heart care through Cleveland Clinic’s national employer-based insurance network. “Together, our goal to develop and provide...

Tiebreaker Vote in Senate Opens ACA Repeal, Replacement Debate

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In a 50-50 procedural vote, Vice President Mike Pence broke the tie as the US Senate voted to open debate for a future vote on American Health Care Act (AHCA), and the possible addition of amendments to the bill. After failing to garner...

Humana Foundation Awards $735K To Improve Community Health

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The Humana Foundation announced awards totaling $735,000 to help South Florida nonprofits to help improve community health. As part of the payer’s philanthropic pursuits, the grants are being awarded during their 2017 donation cycle to...

BCBS of Louisiana Offers Online Consumer Price Comparison Portal

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In an effort to improve transparency and customer engagement, Blue Cross Blue Shield (BCBS) of Louisiana launched an online consumer price comparison portal. The portal, called SmartShopper, allows any BCBS  customer in Louisiana to compare...

Sick Members More Likely to Leave Medicare Advantage Plans

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A recent study of the Medicare Advantage (MA) landscape shows that sicker members are leaving their plans in greater numbers than their healthy counterparts. The study by the non-partisan Government Accounting Office (GAO) evaluated 126...

Commercial Payer Prices Outpace Medicare, Medicare Advantage

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Commercial payers charge significantly higher prices for common clinical services than Medicare fee-for-service (FFS) and Medicare Advantage plans, according to a new report from the Congressional Budget Office (CBO). Commercial insurers charged...

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