The House of Representatives has passed HR 1418, the “Competitive Health Insurance Reform Act,” reintroducing questions about whether healthcare payers should be allowed to fall under an...
In the first part of its Advance Notice for calendar year 2022, CMS has proposed completely phasing in the CMS-Hierarchical Condition Categories (HCC) for Medicare Advantage risk adjustment, finalizing...
Although the interoperability rule will not be implemented until mid-2021, payers can be aware of what to expect regarding how this rule will change their processes, as outlined in a recent AHIP...
On August 14, the Federal Circuit court made two decisions affecting payers which centered around practices meant to lower costs for Affordable Care Act marketplace enrollees: government reimbursement...
The Centers for Medicare and Medicaid Services (CMS) announced that it will allow payers to use premium credits to temporarily lower the individual and small group exchange premiums for...
The Massachusetts State Senate has passed a bill that would introduce step therapy reform, restricting a practice that payers commonly use to decrease patient prescription drug...
The average basic premium for Medicare Part D prescription plans will be the second lowest average Part D premium since 2013, CMS announced.
“The Trump Administration has prioritized policies...
The US District Court of Appeals for the District of Columbia Circuit upheld the Trump Administration’s decision to extend the potential duration of short-term limited duration health plans.
The...
America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) have called on Congress to ensure access to coronavirus care and healthcare coverage through federal...
With New Jersey’s small group health insurance market in decline, the New Jersey Health Care Quality Institute (Quality Institute), a nonpartisan group that advocates for collaboration among...
Oklahoma is now the first state to turn to Medicaid expansion during the coronavirus pandemic, a state ballot determined.
The vote passed by a margin of less than one percentage point, local news...
The House of Representatives voted to expand the Affordable Care Act only days after the White House reiterated its resolve to dismantle the Affordable Care Act altogether.
The House of...
Major payers and payer organizations objected to the finalized HHS nondiscrimination rule—Affordable Care Act Section 1557—saying that the rule eliminates much of the specific language in...
New York’s experience during the Great Recession could inform its approach to coronavirus Medicaid during the pandemic, a recent report from the United Hospital Fund suggested.
For more...
While overall out-of-network or potential surprise billing is slightly declining, out-of-network healthcare spending is on the rise for laboratory tests and hospitalists—particularly in...
More than 1,750 Medicare Advantage and Medicare Part D plans will participate in the Part D Senior Savings Model in order to offer lower insulin costs in 2021, CMS announced.
“President Trump...
The coronavirus pandemic sparked a rise in telehealth use. Video and audio visits allow patients to connect with their providers virtually, eliminating the risk of a clinic visit. Meanwhile, remote...
CMS has finalized changes to Medicare Advantage and Medicare Part D telehealth policies and supplemental chronic disease management benefits. The agency has also expanded Medicare Advantage for rural...
Update 5/22/2020: This article has been updated to reflect that the one-sided risk corridor in the HEROES Act applies to individual and small group markets as well as self-insured and large group...
The Internal Revenue Service (IRS) has issued guidance extending flexibilities to high deductible health plan (HDHP), employer-sponsored cafeteria plan, and flexible spending arrangement (FSA) plan...
