Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

November 17, 2017 - As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in 2019. In an analysis released this week, CBO and JTC estimated that a repeal of the mandate would reduce the federal deficit by $338 billion between 2018 and 2027,...


Articles

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

by

AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group believes...

Top 5 Most Common Healthcare Provider Fraud Activities

by

Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants in...

Providers Caught in Medicare Fraud Schemes Topping $200M

by

Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law enforcement...

Maine Referendum Expands Medicaid Despite Governor Opposition

by

The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine residents...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

by

CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in an...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

by

ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have gone from...

Providers Seeing Even Mix of Public, Commercially Insured Patients

by

Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three percent...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

by

(CSRs) under the Affordable Care Act, payers were expecting only modest premium increases and some continued profitability, according to a USC Brookings report. However, the uncertainty resulting from federal waffling over the continuation of...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

by

The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the Congressional...

Alexander-Murray Bill Offers ACA Market Stabilization, Flexibilities

by

A new bipartisan bill proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) is an attempt to stabilize and protect provisions of the ACA while allowing for greater state flexibility to manage healthcare. The Bipartisan Health Care...

Iowa Withdraws 1332 Waiver for Insurance Market Stabilization

by

Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.   The proposed stopgap measure  included a single, standardized plan available to every...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

by

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...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

by

Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many Affordable...

Payers Express Concern Following Cost-Sharing Reduction Cuts

by

Several payer organizations have expressed deep concerns after President Trump announced plans to end the cost-sharing reduction (CSR) subsidies for ACA individual plans.. Organizations including AHIP, AMA, and AHA have previously urged Congress...

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

by

The White House has announced plans to scrap the Affordable Care Act cost sharing reduction subsidies for health insurers that have helped to keep premiums low and stabilize markets subject to the individual mandate. The announcement came just...

Executive Order Eases ACA Rules on Association Health Plans

by

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...

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

by

Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office of the...

Senate to Vote on Funding CHIP for Five Additional Years

by

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

by

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....

X

Sign up for our free newsletter:

Our privacy policy

no, thanks