Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

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Iowa Insurance Commissioner Doug Ommen has withdrawn his state’s application for a 1332 waiver to stabilize its insurance markets in 2018.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...

Senate to Vote on Funding CHIP for Five Additional Years

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A bipartisan bill to continue CHIP funding for five more years and transition to a state-federal partnership will move to a Senate vote after being approved by the Senate Finance Committee.   The “Keep Kids’ Insurance...

HHS Nixes Proposed Rule for Health Plan Compliance Documents

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HHS has withdrawn a proposal for a rule that would have required controlling health plans (CHPs) to submit additional information and documentation demonstrating compliance with HHS operating rules, the agency posted in the Federal...

Medicaid Directors Voice Concerns for Graham-Cassidy Bill

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The National Association of Medicaid Directors (NAMD) argues that a hasty passage of the Medicaid reforms presented in the Graham-Cassidy bill will have significant consequences for public payer programs and the health outcomes of their...

Planning for Individual Insurance Exchange Stabilization in WA

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State health insurance markets and their individual insurance exchanges have faced regular instability in the form of payer exits, imbalanced risk pools, and rising premiums that push out new and returning insurance consumers. As premiums...

AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients

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AHIP believes that passage of the Graham-Cassidy Bill making the rounds in the Senate would adversely affect payer market through policies that destabilize the health insurance markets, reduce patient access to healthcare, and fail to meet...

Top 10 Healthcare Spending Categories in the United States

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The upward trajectory of US healthcare spending doesn’t seem to be slowing down anytime soon, leaving payers, providers, and beneficiaries wondering how to control costs while maintaining a high level of quality. Value-based...

Veterans Gained Coverage under ACA, but May Lose Big from Repeal

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While the Affordable Care Act (ACA) produced significant coverage gains for veterans, currently proposed repeal actions could hit this population particularly hard, according to a study from RAND Corporation. Prior to the ACA, 9.1 percent...

Healthcare Coverage, Access Disparities Remain Even After ACA

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While the Affordable Care Act has helped to significantly reduce care and access disparities between socioeconomic groups, more work is needed to create true coverage equity, according to a new study from Oregon Health and Sciences...

AARP: Congress Must Take Action on ACA Market Stabilization Solutions

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In order to protect healthcare consumers and stabilize the ACA marketplace, Congress must pass legislation that creates affordable and accessible coverage options, protects Medicaid and Medicare program funding, and expands prescription...

NY Medicaid Inspector General Assists in $125M Fraud Takedown

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The New York Office of the Medicaid Inspector General (OMIG) assisted the Medicaid Fraud Strike Force in uncovering Medicaid fraud totaled $125 million, the office announced in a press release. OMIG and the Strike Force helped other law...

AHIP: Permanently Renew Medicare Advantage Special Needs Plans

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Congress should consider a permanent renewal of the Medicare Advantage Special Needs Plans (SNPs) because of the consumer protections they provide and their market implications, AHIP wrote in a letter to the House of Representatives. A...

AHIP, AMA, AHA to Congress: Fund Cost Sharing Reductions to 2019

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AHIP, AMA, and AHA and four other healthcare organizations urged Congress to continue funding cost sharing reductions (CSRs) through 2019, warning of continued instability in the health insurance marketplace and higher premiums if the CSRs...

GAO: Veterans Affairs Insurance Enrollment Standards Lacking

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The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a new report from the Government...

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