Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

Medicare Advantage Value-Based Insurance Design Updates for 2019

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The Medicare Advantage (MA) Value-Based Insurance Design Model (VBID) for 2019 will extend into fifteen new states, allow Chronic Condition Special Needs plans to participate in the model, and allow all participating plans to specialize...

Medicare Advantage, Part D Updates to Shift Control to Health Plans

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CMS is proposing regulatory changes that would offer health plans additional flexibility to design and implement Medicare Advantage (MA) and Part D Medicare benefits.   The rule would reduce administrative burdens by allowing plans...

ACA Individual Mandate Repeal Could Cut Insured Number By 13M

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As a potential repeal of the ACA’s individual mandate faces the US Senate, the Congressional Budget Office (CBO) and Joint Tax Committee (JTC) found that a repeal would cut the number of insured individuals by four million in...

AHIP Supports Demo of Medicare Advantage Plans as Advanced APMs

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AHIP has voiced its support for a CMS demonstration project that would allow Medicare Advantage (MA) plans to qualify as Advanced Alternative Payment Models (APMs), the organization wrote in a statement to CMS. The payer advocacy group...

Top 5 Most Common Healthcare Provider Fraud Activities

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Healthcare provider fraud is extraordinarily common and can be conducted at a shockingly large scale.  The largest healthcare provider fraud takedown in US history was announced just recently, resulting charges against 400 defendants...

Providers Caught in Medicare Fraud Schemes Topping $200M

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Law enforcement officials continue to crack down on Medicare fraud schemes that siphon millions of dollars from the programs, as individuals submit fraudulent claims or overcharge for unnecessary healthcare utilization. Federal law...

Maine Referendum Expands Medicaid Despite Governor Opposition

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The state of Maine has become the first state to expand Medicaid through a ballot vote that overrides Governor Paul R. LePage’s (ME-R) previous decisions to block the expansion, according to national news outlets. On Tuesday, Maine...

CMS Adjusts Medicaid 1115 State Innovation Waiver Processes

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CMS is attempting to streamline the approval process for Medicaid 1115 state innovation waivers by implementing new policies that prioritize transparency, the agency announced in a bulletin. The agency has adjusted 1115 waiver policies in...

Reinsurance Changes Payers Can Expect Under the ACA in 2018

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ACA federal reinsurance policies have undergone a transformation since their introduction from four years ago. Payers should continue to prepare for larger changes of federal and state ACA reinsurance in 2018. Reinsurance programs have...

Providers Seeing Even Mix of Public, Commercially Insured Patients

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Providers are seeing a fairly even mix of Medicare, Medicaid, and commercially insured patients with fewer uninsured individuals than before the ACA, according to the AMA’s Physician Practice Benchmark Survey. In 2016, forty-three...

Before CSR Cuts, ACA Health Plans Expected Stable Premiums

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Had cost-sharing reductions (CSRs) under the Affordable Care Act remained in place payers would only expect modest premium increases with some continued profitability, a USC Brookings report found. However, the uncertainty...

CBO: Alexander-Murray Healthcare Bill Could Save $3.8B

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The Bipartisan Health Care Stabilization Act of 2017, also known as the Alexander-Murray compromise bill, would save the federal government $3.8 billion without drastically changing the number of individuals with health insurance, the...

Alexander-Murray Bill Offers ACA Market Stabilization, Flexibilities

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A new bipartisan bill proposed by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) is an attempt to stabilize and protect provisions of the ACA while allowing for greater state flexibility to manage healthcare. The Bipartisan...

Iowa Withdraws 1332 Waiver for Insurance Market Stabilization

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Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.   The proposed stopgap measure  included a single, standardized plan available to...

Bipartisan Senate Compromise May Reinstate CSRs, Alter 1332 Waivers

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Senators Lamar Alexander (R-TX) and Patty Murray (D-WH)  have floated a bipartisan deal to reinstate the ACA’s cost-sharing reductions (CSRs) and boost individual enrollment outreach in exchange for alterations to the state 1332...

States Approve Premium Hikes after Loss of Cost Sharing Reductions

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Several states have decided to either increase or maintain expected premium increases on individual and small group plans following the President’s decision to end the cost-sharing reductions (CSRs) that cover the cost of many...

Payers Express Concern Following Cost-Sharing Reduction Cuts

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Several payer organizations have expressed deep concerns after President Trump announced plans to end the cost-sharing reduction (CSR) subsidies for ACA individual plans. Organizations including AHIP, AMA, and AHA have previously urged...

Trump Plans to End Cost Sharing Reduction Subsidies for Payers

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The White House has announced plans to scrap the Affordable Care Act cost sharing reduction subsidies for health insurers that have helped to keep premiums low and stabilize markets subject to the individual mandate. The announcement came...

Executive Order Eases ACA Rules on Association Health Plans

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An executive order signed by President Trump will lighten rules on association health plans (AHPs), which could allow groups of businesses to provide lower cost insurance without essential health benefits (EHBs), as reported by multiple...

Medicare Fraud Schemes Bring Jail Time, Admissions, Repayments

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Medicare fraud is always a risk for such a large program, but federal crackdowns on waste, abuse, and improper payments are serving as a stern warning to providers who may be considering taking advantage of the system.   The Office...

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