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Policy and Regulation News

CMS Mulls End of Auto-Reenrollment, Silver Loading in ACA Market

January 18, 2019 - CMS has issued its proposed Payment Notice for the 2020 plan year, which contains provisions that would significantly alter the operations and structure of the ACA individual marketplace. Continuing a pattern of using CMS regulatory authority to chip away at the integrity of the Affordable Care Act, CMS is seeking comment on a proposal to eliminate auto-reenrollment in plans for...


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NYC Mayor Announces Plan to Guarantee Health Coverage for All Residents

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Mayor Bill de Blasio has announced the launch of a comprehensive, universal healthcare coverage plan that will guarantee benefits for every New Yorker. “Healthcare is a right, not a privilege reserved for those who can afford...

Verma: Price Transparency Rule a “First Step” for Consumerism

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The hospital price transparency mandate that went into effect on January 1 is still ruffling feathers among healthcare providers, leading CMS Administrator Seema Verma to reiterate the importance of giving consumers access to pricing...

CA Governor Addresses Prescription Drug Costs, Healthcare Access

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California Governor Gavin Newsom has announced a series of major executive actions and budget proposals to reduce prescription drug costs and move California closer to the goal of healthcare coverage for all. Newsom’s healthcare...

Hospital Price Transparency Rule Takes Effect January 1, 2019

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Starting January 1, 2019, hospitals will be required to post their price lists online in an effort to increase price transparency and empower consumers to make informed choices about their care. The mandate stems from the 2019 inpatient...

HHS Signals End to Health Plan Identifiers in New Proposed Rule

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Years of pushback from industry stakeholders has motivated an HHS proposal to eliminate a federal requirement for identifying health plans in HIPAA transactions. As everyone prepares to break for the holidays, the federal agency formally...

Better State Policy Needed to Address Social Determinants of Health

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A report on social determinants of health (SDOH) has five recommendations for addressing these important but often overlooked health factors with effective policymaking. The Center for Health Care Strategies (CHCS) recently published...

Coalition of State AGs Challenge Ruling of Unconstitutional ACA

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Following a December 14 ruling stating the Affordable Care Act to be unconstitutional without its individual mandate, attorney generals from 16 states and the District of Columbia filed an expedited motion to bring clarity to the...

TX Judge Rules ACA Unconstitutional in Highly Charged Court Case

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In a highly politically court case brought by a number of Republican officials, US District Judge Reed O'Connor has issued a ruling stating that the Affordable Care Act as a whole is unconstitutional. The ruling stems from the notion...

Trump Administration Touts IPI Model for Reining In Drug Prices

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On average, Americans pay 80 percent more for the costliest physician-administered drugs than patients in other developed countries, according to a key HHS advisor. “Free market advocates and those who have philosophical concerns...

High-Deductible Plans Lead Diabetics to Forgo, Delay Treatment

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Workers with diabetes who switched to high-deductible health plans requiring additional out-of-pocket expenses are more apt to put off necessary check-ups, a new Annals of Internal Medicine study finds. A growing proportion of Americans...

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

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CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

Insured Consumers Struggling With Prescription Drug Costs

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Despite having access to health benefits, 40 percent or more of United States citizens have difficulty affording their prescription drugs. A GoodRx survey of 1,060 respondents about their prescriptions between October 29 and November 2...

Regulatory Changes Needed To Expand Medicare Telehealth Use

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A new report on Medicare telehealth between 2014 and 2016 shows increased utilization of telehealth services by Medicare beneficiaries but largely remains an untapped resource because of restrictive federal rules and...

HHS Sets Sights on Addressing Social Determinants of Health

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Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health spending,” contributing to the $1...

Regulatory Uncertainty Continues to Disrupt ACA Marketplaces

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New research published by the Kaiser Family Foundation provides insight into the forces driving health payers to participate in certain ACA marketplaces while wholly quitting others. Insurer participation in the Affordable Care Act health...

HHS Looks to Medicaid Demonstrations to Improve Mental Health

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Medicaid beneficiaries with mental health conditions are the targets of recent CMS efforts to boost health outcomes. In recent remarks to the National Association of Medicaid Directors in the national capital, HHS Secretary Alex Azar said...

CMS Demonstrations Target Mental Health Services Under Medicaid

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Medicaid beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED) are the targets of recent CMS efforts to improve health outcomes. In a letter to Medicaid directors across the country, the federal agency...

Robocalls Targeted Consumers During Health Plan Enrollment Period

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Health insurance open enrollment’s kicked off, accompanied by a spike in automated calls with offers of Affordable Care Act or other health plans, much to the chagrin of consumers. “It’s at epidemic levels at this time...

CMS Proposes to Deregulate, Fast Track Medicaid Managed Care Programs

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CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates. CMS developed the rule in coordination with the National...

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