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Policy and Regulation News

CMS Proposes Drug Pricing, Price Transparency Changes for Medicare

July 13, 2018 - CMS has proposed a series of policy changes for Medicare that would promote prescription drug affordability within Medicare, and has also requested stakeholder comments about ways to improve price transparency for Medicare services. As part of changes to the 2019 Medicare Physician Fee Schedule (PFS), CMS would adopt a new pricing model for Medicare Part B drugs so that the prices patien...


Articles

CMS Cuts ACA Navigator Funding Grants by $26M for 2019

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CMS has announced a $26 million cut to funding grants for ACA navigators, from $36 million down to $10 million. CMS will provide a minimum of $100,000 in each of the states that operate a federally-facilitated exchange (FFE). The funding wi...

CMS Suspends $10.4B in Risk Adjustment Payments to Payers

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CMS has temporarily withheld $10.4 billion in risk adjustment payments for 654 healthcare payers, citing a ruling in the US District Court of New Mexico that invalidated the agency’s risk adjustment methodology. The ruling, which took...The individual health plan market will lose nearly $7 billion in risk adjustment payments. Small group health plans in the program will miss out on nearly $2 billion in total risk adjustment payments. Catastrophic and merged market plans (w...

Vermont Government Plans Regulations for Association Health Plans

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Vermont’s Department of Financial Regulation (DFR) is planning to implement emergency rules and regulations for association health plans (AHPs) following the Department of Labor’s final rule to allow AHP sales nationally. DFR sa...

CMS: Individual Health Plan, Federal Exchange Challenges Remain

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CMS has released three new reports indicating that the individual health plan and federal exchange markets faltered somewhat in 2017 because of increasing premiums, decreasing competition, and stagnant enrollment. The agency believes that t...Fifty-seven percent of individual health plan enrollees in the US received a CSR for the remainder of plan year 2017. Additionally, 84 percent qualified for an APTC as well. Federal exchange consumer satisfaction increased from 2016 to 2017...

DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

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HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2 b...

Federal Court Strikes KY 1115 Medicaid Waiver Work Requirements

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The US District Court for the District of Columbia has blocked Kentucky from implementing work requirements within its 1115 Medicaid waiver demonstration, despite CMS approval of the community engagement provisions. The court ruled that add...

CMS Approves Okla. Value-Based Drug Purchasing for Medicaid

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CMS has approved the nation’s first value-based drug purchasing agreement for Medicaid by allowing Oklahoma’s state program to negotiate supplemental prescription drug rebates based on treatment outcomes. CMS allows state Medica...

CMS to Develop New Medicaid Program Integrity Initiatives

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CMS has announced a new set of Medicaid program integrity initiatives that leverage enhanced data sharing, claims auditing, and provider education to reduce the incidence of improper payments and help secure program finances. In 2016, Medic...

Senators: Stop $89B in Medicare, Medicaid Improper Payments

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The US Senate Budget Committee has penned a letter to HHS Secretary Alex Azar urging the department to address approximately $89 billion in improper payments within Medicare and Medicaid. The Senators referenced a recent GAO report suggeste...

Department of Labor Finalizes Association Health Plan Expansion

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The Department of Labor (DOL) has issued a final rule that expands consumer availability of association health plans (AHPs) starting on September 1, 2018. The rule comes months after President Trump and the DOL proposed executive changes th...

US Court: Payers Are Responsible for Risk Corridor Program Costs

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Federal judges in the US Federal Circuit Court of Appeals have issued an opinion stating that healthcare payers, and not HHS, are responsible for the costs of the ACA’s risk corridor program. Chief Judge Sharon Prost filed the majorit...

AHIP, Provider Groups Balk at DOJ Position on ACA Mandates

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AHIP and a number of professional societies and provider groups are urging the Trump Administration to enforce key provisions of the the Affordable Care Act after the Department of Justice (DOJ) said it would not defend the ACA in a federal...

Department of Justice Argues Against ACA Essential Health Benefits

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The Department of Justice (DoJ) has argued against the Affordable Care Act’s essential health benefits (EHBs) and the law’s individual mandate by supporting a lawsuit that argues the constitutionality of both laws, Attorney...

President Trump Signs Bill to Expand Privatization of VA Healthcare

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President Trump signed the Veterans Affairs’ Mission Act into law midweek which will provide over $50 billion in federal investments to privatize a portion of the VA’s healthcare system and improve historical inefficiencies. The...

Maine Court to Force Medicaid Expansion Past LePage’s Block

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A state-level court in Maine has forced Governor Paul LePage (R) and the Maine Department of Health and Human Services (DHHS) to uphold a ballot initiative that implements Medicaid expansion under the Affordable Care Act (ACA). Justice...

ACA’s Individual Mandate Boosted High-Income Enrollment Totals

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The Affordable Care Act’s (ACA) individual mandate spurred greater high-income enrollment in health plans and is a key component of increasing enrollment and stability in the nation’s individual insurance markets, according to a...

CMS Medicaid Scorecards Increase Transparency, Accountability

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CMS has released new Medicaid scorecards that contain care quality data on a state-by-state basis in order to improve transparency and accountability across the Medicaid program. CMS Administrator Seema Verma emphasized a need for increased...

Virginia Legislature Approves Medicaid Expansion

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The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid under ...

GAO Appoints Public Policy, Payment Experts to MedPAC

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The Government Accountability Office (GAO) has appointed five new public policy and healthcare payment experts to the Medicare Payment Advisory Commission (MedPAC). GAO chief Gene L. Dodaro, Comptroller General of the United States, is conf...

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