Policy and Regulation News

CO Public Option Bill Paused, Unemployment Rises Due To COVID-19

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The Colorado House of Representatives laid aside the public option proposal, the Colorado Health Care Option, in light of coronavirus. Three members of the Colorado House of Representatives wrote a...

Medicaid, CHIP Amendments Help States Fight COVID-19 Outbreak

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Waivers to Medicaid and the Children’s Health Insurance Program (CHIP) give state programs flexibility to better respond to COVID-19.   For more coronavirus updates, visit our resource...

Supreme Court Rules Federal Government Must Pay $12B to ACA Insurers

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In an 8-1 decision, the Supreme Court has ruled that the federal government must pay $12 billion to insurers enrolled in the Affordable Care Act’s risk corridor program. The risk corridor...

CMS Delays Interoperability Final Rule Roll Out Due to COVID-19

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Because hospitals, health systems, and providers are on the frontlines of treating and covering patients with COVID-19, the Centers for Medicare and Medicaid Services (CMS) decided to extend the...

Payers Recommend Actions To Promote Biosimilars, Drug Competition

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The Food and Drug Administration (FDA) and Federal Trade Commission (FTC) can streamline the biosimilar approval process and adopt other strategies to promote biosimilars and lower healthcare spending,...

An Overview of the FFCRA, CARES Act Coronavirus Testing Rules

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CMS has issued guidance for private health plans regarding coverage for coronavirus diagnostic testing and relevant products and procedures. For more coronavirus updates, visit our resource page,...

CMS Finalizes MA and Part D Rates, Leaves ESRD Rule Unchanged

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CMS has finalized its Medicare Advantage and Part D rates, including finalizing the disputed Medicare Advantage end-stage renal disease (ESRD) payment rule without changes. CMS anticipates a slight...

What The Families First Coronavirus Response Act Means for Payers

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The Families First Coronavirus Response Act, the second relief package for the coronavirus pandemic, passed on March 18 with an overwhelming majority in the House and Senate. The act extends...

Fiscal, Health Challenges That Coronavirus Poses To The Uninsured

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While for many in the US the novel strain of coronavirus sweeping the nation seems to pose little threat and some question the need for stringent mitigation measures, researchers from the Kaiser Family...

CMS Urges Medicaid Expansion Amid Coronavirus Emergency

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On March 13, the Trump Administration declared the spreading coronavirus (COVID-19) a national emergency. CMS immediately followed with various resources, including a factsheet from March 5 about...

AHIP: 3 Factors to Consider for CMS Data Interoperability Rule

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Reactions to the finalized interoperability rule have fallen predictably along industry lines, as payers and providers spurn the new rules but technology companies warm up to them. For more...

CMS Targets Medicare Advantage Beneficiaries In COVID-19 Efforts

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CMS has released guidance regarding how Medicare Advantage and Part D Plans can properly respond to the COVID-19 outbreak. For more coronavirus updates, visit our resource page, updated twice...

How Will Health Literacy Affect Interoperability Rule Benefits?

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With its new interoperability rule, CMS pushed ahead with the anticipated mandates, which direct payers to provide Patient Access application programming interfaces (APIs) and Provider Directory APIs,...

How the Affordable Care Act Impacted the Individual Market

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Reforming the Affordable Care Act (ACA) has had lasting impacts on the individual health insurance market. Intending to reshape a dysfunctional system, the ACA included incentives for insurers to...

Do Short-Term Limited Duration Plans Deserve Industry Skepticism?

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Short-term limited duration policies may provide lower premium rates, but when patients contract unexpected, high-cost health conditions, these plans may leave members exposed to higher out-of-pocket...

SCOTUS Will Review ACA Constitutionality, Decision Expected 2021

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Update 03/03/2020: This article has been updated to include a statement from America’s Health Insurance Plans (AHIP) on the Supreme Court’s decision to review the case. The Supreme...

Experts Lambast CMS MFAR as Detrimental to Employers, Patients

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The US Chamber of Commerce is the most recent opponent to the CMS Medicaid Fiscal Accountability Regulation (MFAR), joining governors, providers, and payers in its disavowal of the rule’s...

Bill on Surprise Medical Billing Moves Forward to Full House Vote

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A bipartisan vote in the House Committee on Education and Labor advanced the Ban Surprise Billing Act on February 11, which aims to reduce surprise billing and increase healthcare transparency. The...

ESRD Proposal May Inadequately Reimburse Medicare Advantage Plans

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While payers and Medicare Advantage proponents applauded elements of the Medicare Advantage rule that CMS proposed yesterday which will increase plans’ revenues by nearly one percent, many...

Post-ACA Access to Care, Coverage Disparities Shifted in 2017

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From 2016 to 2017, the uninsured rate rose by 1.2 percent and the number of persons who avoided care due to cost rose by 1.0 percent, demonstrating a shift in healthcare trends that started with the...