Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

VA Union: Investigate $90M in Third-Party Contractor Payments

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The American Federation of Government Employees (AFGE) has sent a letter to VA leadership proposing an investigation into $90 million of improper payments made to the third-party contractors of the Veteran’s Choice program. The...

IT Investment to Help VA Speed Claims Administration, Payment

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The Department of Veterans Affairs (VA) has announced new goals for claims administration and a significant investment in health IT tools that will help coordinate payment for community providers. The VA has set the goal of increasing the...

Proposed Rule Details Association Health Plan Expansion Guidelines

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The Department of Labor (DoL) released a proposed rule that allows small businesses and employee groups to purchase association health plans (AHPs) in lieu of employer-sponsored or individual health insurance. The rule follows an...

Affordable Care Act Changes May Bring a Rocky 2018 for Payers

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2017 was a turbulent year for the Affordable Care Act.  Legislative battles in Congress, fluctuating support from healthcare stakeholders, and threats of repeal have left many payers facing an uncertain future. Even though Congress...

MS Awarded 10-Year Extension of 1115 State Medicaid Waiver

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Mississippi will be the first state to receive a 10-year extension of a 1115 Medicaid waiver, CMS announced.  The waiver originally implemented in 2003, expands eligibility requirements for individuals who can receive family planning...

DoJ Recovered $2.4B from Healthcare Fraud Schemes in 2017

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The Department of Justice (DoJ) recovered $2.4 billion from federal healthcare fraud cases during 2017, the agency announced in a press release. Healthcare-related fraud recoveries accounted for 64 percent of the DoJ’s $3.7 billion...

MI Requests Renewal of “Healthy Behaviors” 1115 Medicaid Waiver

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Michigan is asking CMS for a renewal of its 1115 Medicaid waiver demonstration that increased the number of insured individuals in the state and led to a reduction in unhealthy behaviors. The demonstration, entitled the “Healthy...

Medicare Advantage Cost Benchmarks Create Plan Inefficiencies

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New research from the Commonwealth Fund found that the Medicare Advantage (MA) benchmark bidding system, which was intended to reduce plan inefficiencies, has allowed health plans to benefit financially while remaining cost...

2018 ACA Open Enrollment Totaled 8.82M Beneficiaries in Last Week

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Approximately 8.82 million beneficiaries enrolled in a health plan during the seven week 2018 ACA open enrollment period, which experienced surges in health plan purchasing activity during the final two weeks. The opening week of...

Federal Tax Bill, Individual Mandate Repeal Passes House and Senate

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GOP lawmakers in both the House and Senate passed a federal tax bill that includes a repeal of the ACA’s individual mandate to purchase health insurance.  The bill now heads back to the House for a procedural vote and afterwards...

Consumers Support Laws to Limit Payer Prescription Switching

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The vast majority of patients living with chronic diseases would support legislation to limit a payer’s ability to switch their prescriptions without medical necessity, according to a new series of surveys.   Ninety-four...

AHIP, BCBS: Association Health Plan Expansion Presents Concerns

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An October executive order that expands the availability of short-term association health plans (AHPs) could present significant challenges for state governments and consumers, asserted AHIP, BCBS, and a number of other payer organizations...

State Medicaid 1115 Waivers Expand Eligibility, Stabilize Premiums

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A number of state governments have submitted Medicaid 1115 waivers to CMS in order to expand Medicaid eligibility requirements, stabilize their in-state premium rates, manage public health issues, and improve behavioral health...

Senate Hearing Opens Policy Discussion on Prescription Drug Costs

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At a Senate HELP Committee hearing this month, policy experts and advocacy groups suggested several strategies that could lower prescription drug costs, including removing Medicare Part D cost-sharing, increasing federal oversight of the...

Individual Mandate Repeal Would Lead to Payer Financial Losses

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A repeal of the individual mandate, as included in the current GOP Senate tax reform plan, would result in financial losses for payers that could not be offset by cost-sharing reduction payments, the Academy of American Actuaries says....

Prescription Drug Spending Cuts Require Payer Policy Changes

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The US’s current prescription drug policies require updates that cut prescription drug spending while increasing competition in the market, a new report from the National Academies of Sciences, Engineering, and Medicine (NASEM)...

Commercial Payer, Medicare, Medicaid Fraud Cases Top $49.1M

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The Department of Justice (DoJ) recently detailed three cases of healthcare fraud targeting private payers, Medicaid, and Medicare that totaled $49.1 million. The schemes involved common fraud tactics such as illegal kickback operations...

Senate Passes Tax Bill, Individual Mandate Repeal in 51-49 Vote

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The US Senate voted 51-49 to reform national tax policy and simultaneously repeal the Affordable Care Act’s individual mandate, major news outlets reported at the end of last week. GOP senators only lost one Republican vote and were...

HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance

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HHS is launching a pilot program that streamlines reviews of health plan HIPAA compliance, the organization announced in an email to the CMS listserv. The HHS HIPAA Administrative Simplification Optimization Project pilot is an effort to...

CMS Updates Payer Guidelines for 2019 Qualified Health Plans

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CMS has issued a draft letter that outlines guidelines, dates, reporting, and regulatory requirements for payers that want to sell qualified health plans (QHPs) in 2019. The Annual Letter to Insurers includes new information, and updates...

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