Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

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...

GAO: CMS Needs More Data to Manage Medicare Opioid Risks

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The Government Accountability Office (GAO) has recommended that CMS should collect additional data on Medicare beneficiary opioid risks, including the number of beneficiaries with high-dose opioid prescriptions, the number of providers...

AHA Makes Suggestions for In-State Insurance Market Stabilization

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In order to stabilize in-state insurance markets, stakeholders should consider strategies including reinsurance, Medicaid-sponsored health plans, and high-risk pools, according to the AHA. Several factors are contributing to unstable...

GAO: Medicaid Home, Community Care Create Financial Conflicts

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Home and community-based services (HCBS) programs funded by Medicaid require additional protections from possible financial conflicts of interest, a new GAO report found. Program assessors, including HCBS providers, state and local...

Provider Health Insurance Fraud Schemes, Settlements Top $310M

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Law enforcement agencies and federal healthcare administrators including HHS, the Office of the Inspector General (OIG), the FBI, and US Attorney's Offices across the country investigated provider healthcare schemes that defrauded...

KY Gets Approval for 1115 Medicaid Waiver with Work Requirements

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Kentucky is the first state to receive approval for a 1115 Medicaid waiver demonstration that adds work requirements in order for able-bodied adults to be eligible for the public health insurance program. The Kentucky Health program...

VA Updates Emergency Care Reimbursement, Payment Activities

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The VA has announced that it will expand provider payment eligibility for emergency treatment services and make  administrative and regulatory changes aimed at creating payment process improvements. The January 9th, 2018 rule extends...

CMS to Test Medicaid Waiver “Community Engagement” Incentives

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CMS plans to support the addition of “community engagement” incentives to state 1115 Medicaid waivers that contain work eligibility requirements for able-bodied adults, the agency announced in a press release. The new policy...

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