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Policy and Regulation News

AR Medicaid Demonstration Adds 9-Month Re-Enrollment Block

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Arkansas received approval from CMS for a 1115 Medicaid demonstration that adds work requirements for Medicaid eligibility and adds a nine-month block on member re-enrollment if individuals don’t find work. Arkansas’...

BCBS Earned Positive ACA Health Plan Revenues in Uncertain Market

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BlueCross BlueShield of North Carolina (BCBS of NC) earned positive ACA health plan revenues after years of financial losses, citing low medical claims and more available consumers after other payers exited the sale of plans through...

Idaho’s Expansion of Association Health Plans Risks ACA Market

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The Academy of Actuaries warned insurance officials and government leaders in Idaho that the decision to expand the sale of association health plans (AHP) will destabilize ACA individual health plan risk pools and reduce essential health...

Latest Medicare Fraud Schemes Targeted $139.4M via Kickbacks

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Three Medicare fraud schemes in recent weeks have targeted a total $139.4 million, which led the Department of Justice (DoJ) to seek multiple convictions and a combined 33 years in prison sentences. Each of the schemes involved the use of...

Uninsured Adults Apprehensive About Health Insurance Costs

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About 71 percent of uninsured adults aware of open enrollment periods did not enroll in state or federally-based health plans because of apprehension to rising health insurance costs and waning confidence that the ACA will remain in...

Value-Based Care Key to Bipartisan Healthcare System Reform

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A group of five governors developed a bipartisan plan to reform the US healthcare system by using value-based care strategies such as quality reporting, insurance stabilization policies, and encouraging consumers to have a more proactive...

GAO: Insufficient Data on Success of 1115 Medicaid Demonstrations

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State and federal evaluations of 1115 Medicaid demonstrations have insufficient data to determine demonstration success because states tend report fragmented program results, according a new GAO report. Currently, there are thirty-four...

Reinsurance, CSR Reinstatement May Stabilize Individual Premiums

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AHIP supports a number of policy solutions that could reverse Trump Administration actions that have resulted in higher premiums and unstable markets. In a new policy brief, the payer advocacy group suggests that lawmakers focus on the...

CMS Proposes 9-Month Extension of Short-Term Health Plans

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CMS is proposing that consumers should be allowed to stay on short-term health plans, including association health plans, for twelve months at a time, despite the fact that these plans are generally non-compliant with the Affordable Care...

Idaho Prepares to Offer Association Health Plans to Consumers

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Idaho will allow payers to offer association health plans (AHPs) that are not required to meet all of the consumer protections or benefits criteria included in the Affordable Care Act.   Governor C.L. “Butch” Otter...

2019 HHS Budget Aims for ACA Repeal, Public Payer Savings

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The newly proposed HHS Budget for fiscal year (FY) 2019 says a repeal and replace of the Affordable Care Act (ACA) would save the government trillions, while restructuring Medicare and Medicaid could produce federal savings. The budget...

Modernizing Medicare Fee-for-Service Cost-Sharing Has Trade Offs

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Medicare’s fee-for-service (FFS) cost-sharing design requires modernization to protect beneficiaries from catastrophic costs, but changing the current design may bring new financial concerns, a new GAO report found. In 2015,...

House Bill Retains Low-Quality Medicare Advantage Plans until 2027

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Update on 2/12/2018: Presdient Trump signed the spending bill into effect on Feburary 9th, 2018 which funds the government for two years and extends quality deadlines for Medicare Advantage plans.  The latest government spending bill...

Alaska Bill to Alter Emergency Room Payment Rules Brings Concern

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A bill in the Alaska Senate intended to repeal protections around emergency room payments has drawn significant concern from the state’s chapter of the American College of Emergency Physicians (ACEP).  The bill would remove a...

Medicare Fraud Cases Lead to Mix of Convictions, Settlements

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The Department of Justice’s (DoJ) crackdown on Medicare fraud continued as new investigations led to one provider conviction and two multi-million dollar settlements with provider organizations. The conviction found a provider...

CMS Releases Proposed Medicare Advantage, Part D Changes

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CMS has released the second part of its proposed Medicare Advantage (MA) and Medicare Part D changes, which include administrative upgrades to assist with combating the nation’s the opioid crisis and allowing payers to incorporate...

Academy of Actuaries Reaffirms Association Health Plan Risks

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The American Academy of Actuaries released a statement reaffirming its concerns with expanding association health plan (AHPs) availability in light of perceived risks to the individual insurance marketplace. The statement precedes...

ACA Implementation Led to Varied Out-of-Pocket, Premium Spending

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Affordable Care Act (ACA) implementation led to an 11.9-percent decrease in out-of-pocket spending but also a 12.1-percent increase in premium spending totals, according to a study published in JAMA Internal Medicine. The landmark...

VA, HHS Announce Healthcare Fraud Prevention Partnership

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The Department of Veterans Affairs (VA), HHS, and CMS agreed to participate in a healthcare fraud prevention partnership that leverages data sharing to identify fraud and abuse within healthcare programs they collectively oversee. The...

Healthcare Orgs Commend Vote to Fund CHIP for 6 Years

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A number of healthcare stakeholders and provider groups have praised bipartisan legislation that re-authorizes CHIP funding for the next six years. Democratic members of the House and Senate agreed to pass a stopgap government funding...

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