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Policy and Regulation News

Balance Billing Hits Patients with Surprise Healthcare Costs

June 21, 2017 - Patients who received treatment within an in-patient network can still face surprise healthcare costs from balance billing. Balance billing occurs when an individual receives an unforeseen bill for treatment by an out-of-network provider, even while being treated at an in-network facility.  The unexpected balance bill can be devastating to the patient, who often had no idea that the provider...


Articles

CMS Outlines Special Enrollment Period Rules for ACA Exchanges

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Starting on June 23, 2017, CMS will be enacting its new rules regarding special enrollment periods (SEP) for the ACA marketplace.  The agency released the new special enrollment rules earlier this year that will alter participation criteria...

AMA, AHA Call for Stronger Patient Insurance Protections

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The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The move by eight of the nation’s leading...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

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If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Nevada Legislature: All Residents Should Have Medicaid Access

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The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

AHCA CBO Score Predicts 23M Uninsured, Higher Out-of-Pocket Costs

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The CBO report on the American Health Care Act (AHCA) found the bill would result in 23 million people losing insurance coverage over the next decade.  Other impacts of the bill include higher out-of-pocket costs for most patients and significant...

WA Health Insurance Exchange In Flux With CSR Confusion

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Washington State has thus far been a success for the health insurance exchange marketplace.  The state has seen robust payer participation, increased enrollment and a trend-bending eight percent benchmark premium increase in 2017, versus...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

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Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC joins a chorus of support for two bipartisan...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

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The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk pools...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

Maine Medicaid Waiver Would Increase Patient Responsibility

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Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

BCBS Moves into Vacant TN Health Insurance Exchange

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Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville area....

Medicaid Waiver Adds More Beds For Drug Addiction Treatment

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To circumvent an obscure Medicaid requirement, seven more states applied to join California, Maryland, Massachusetts and New York to receive a Medicaid waiver to expand drug addiction treatment.   Current federal policy prohibits the...

Are Health Insurance Subsidies Enough for Low-Income Patients?

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Despite financial penalties designed to prompt consumers to keep their health insurance, current efforts to subsidize care for low-income individuals may not be enough to incentivize patients, according to a recent study by economists at MIT...

Healthcare Orgs React to House Vote on American Health Care Act

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The House vote to pass the American Health Care Act (AHCA) has drawn responses from across the healthcare industry.    The bill was passed 217-213, and immediately created a firestorm of commentary.  The passage of the bill...

House Passes AHCA To Repeal and Replace ACA By 1 Vote Margin

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The House has successfully passed the American Health Care Act (AHCA) to repeal-and-replace the ACA.  This was the House GOP’s second attempt to pass the bill, after the first vote was abruptly cancelled by Speaker Paul Ryan in...

AHIP Sees 28% Increase in Medigap Enrollment Among Seniors

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AHIP has released data showing that enrollment in the Medicare Supplement, Medigap, has seen a steady increase from 2014 to December 2015.   The data represents statistics from 11.8 million enrollees with policies from 305 separate...

Payers Offer 10 Ways to Improve Cost, Quality of Long-Term Care

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The National Association of Insurance Commissioners (NAIC) issued ten long term care (LTC) federal policy recommendations to Congress.   The report was completed as part of the group’s Retirement Security Initiative.  NAIC...

Court Upholds Antitrust Ruling Against Anthem-Cigna Merger

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On Friday, a federal DC district appeals court upheld a February 2017 decision which blocked the acquisition of Cigna by health insurance giant Anthem.  Antitrust concerns led 11 states and the District of Columbia to join the US Justice...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

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Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

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