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Policy and Regulation News

GAO Finds Several Medicare Beneficiary Data Vulnerabilities

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CMS may have significant Medicare beneficiary data vulnerabilities because of security standards gaps within organizations that review and audit Medicare performance, a new GAO report found. GAO found security risks based on discrepancies...

11.8M Members Bought Health Plans Via Affordable Care Act Exchanges

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Nearly 11.8 million beneficiaries have enrolled or re-enrolled in a health plan through the Affordable Care Act exchanges, reaching close to 2017 enrollment totals (12.2 million) despite federal changes in how the exchanges are funded and...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

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The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent...

CMS Final Rule Aims to Lower Medicare Prescription Drug Costs

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CMS is planning to lower Medicare prescription drug costs through a final rule that allows members to purchase less expensive biosimilars and generic drugs and increases the potential value of Medicare Advantage (MA) and Part D plans. CMS...

OIG: Medicaid Fraud Control Units Recovered $1.8B in 2017

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Medicaid fraud control units (MFCUs) recovered $1.8 billion in 2017 through effective collaboration with state governments, according a new report released by the Office of the Inspector General (OIG). MFCUs recovered $6.52 for every...

Iowa Gov. Approves Expansion of Association Health Plans

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Governor Kim Reynolds has signed a bill that will allow small groups and agricultural associations to create association health plans (AHP) that operate outside of the individual health plan market. Senate File 2349 requires associations...

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

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CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from...

AL Medicaid Work Requirements Linked to Health Equity Challenges

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Alabama’s proposed Medicaid work requirements are likely to lead to health equity challenges by inadvertently creating eligibility barriers for vulnerable populations, according to research from the Georgetown Health Policy...

Payers Will Face Individual Health Plan Market Challenges in 2019

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Payers participating in the individual health plan market will face challenges in 2019 based on the planned expansion of association health plans (AHPs), increased competition, and changing provider negotiations, according to the Urban...

Proposed Legislation May Lower Individual Premiums by 40%

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Senator Lamar Alexander (R-TN), Senator Susan Collins (R-ME), House Energy and Commerce Committee Chairman Greg Walden (R-OR) and Representative Ryan Costello (R-PA) have proposed legislation that aims to lower individual health plan...

Tavenner Steps Down from AHIP, Hands Leadership to Matt Eyles

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The AHIP Board of Directors has appointed Matt Eyles as the organization’s new President and CEO to replace Marilyn Tavenner after she retires on June 1st, 2018.    Eyles was elected unanimously as Tavenner’s...

Individual Insurance Premiums to Soar Without Policy Actions

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Individual insurance premiums may rise between 12 and 32 percent nationally by 2019, with cumulative increases of 34 to 94 percent by 2021, according to new research conducted by health plan actuaries and experts at Harvard, UCLA, and UC...

CMS: Idaho Association Health Plan Expansion Violates ACA

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CMS Administrator Seema Verma informed Idaho governor C.L. “Butch” Otter (R-ID) and state insurance officials that efforts to launch an expansion of association health plan (AHPs) sales violates the market protections...

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...

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