Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

Governors Propose Health Insurance Market Stabilization Plan

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Eight state governors have outlined their proposals for a health insurance market stabilization plan that would control premium increases and improve competition in the federal and state health insurance exchanges. In a letter sent to...

HHS to Spend $10M on Affordable Care Act Navigator Program

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HHS and CMS announced that they will allocate $10 million to support the Affordable Care Act Navigator program, which helps health insurance consumers find coverage solutions during the Open Enrollment period. Launched in 2013, the...

20.5 Million More Insured Since Start of Affordable Care Act

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20.5 million more individuals have gained health insurance coverage since the implementation of the Affordable Care Act (ACA) in 2010, according to a new report from the CDC and the National Center for Health Statistics (NCHS). In the...

Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

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Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release. Declared...

CMS: Payers Will Have More Time to File 2018 Health Plan Rates

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Payers still debating how uncertainty over cost-sharing reduction (CSR) subsidies will alter their insurance prices now have more time to submit 2018 health plan rates, CMS announced in a letter to insurers. While the letter says...

As ACA Debate Lingers, Non-Marketplace Members Present Risks

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While much of the national debate over health insurance has focused on the options open to ACA marketplace enrollees, payers should be careful not to neglect coverage choices for their private plan customers, who tend to be healthier and...

Payers, Providers Highlight the Pros of Cost-Sharing Reductions

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A joint group of America’s Health Insurance Plans (AHIP) and provider organizations came together to promote the benefits of cost-sharing reductions (CSRs) on consumer and payer healthcare costs, the group announced in a joint...

ACA “Skinny Repeal” Dies in Senate, Leaving Next Steps Uncertain

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In the early hours of Friday morning, the Senate failed to pass its attempt at a “skinny repeal” of the Affordable Care Act, which would have eliminated the tax penalties associated with the individual mandate for insurance...

Senate Nixes Better Care Reconciliation Act, But Isn’t Done Yet

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After a nail-biting procedural vote on Tuesday afternoon that required Vice President Mike Pence to break the tie, the Senate continued its tumultuous afternoon by voting down the Better Care Reconciliation Act, which included deep cuts to...

Tiebreaker Vote in Senate Opens ACA Repeal, Replacement Debate

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In a 50-50 procedural vote, Vice President Mike Pence broke the tie as the US Senate voted to open debate for a future vote on American Health Care Act (AHCA), and the possible addition of amendments to the bill. After failing to...

DoJ Charges 412 in Medicare Fraud Schemes Totaling $1.3B

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The Department of Justice (DoJ) announced the largest ever healthcare enforcement action in the history of the federal agency took place when the Medicare Fraud Strike Force (MFSF) charged 412 defendants for Medicare fraud losses totaling...

Increasing Competition Can Reduce Prescription Drug Prices

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Reducing prescription drug prices for payers requires market-based solutions that increase competition and deregulate federal drug policies, the Pharmaceutical Care Management Association (PCMA) wrote in a letter to HHS secretary Tom...

AHA to CMS: Continue Funding ACA Cost-Sharing Reductions

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CMS should continue to fund the cost-sharing reductions (CSRs) that keep the Affordable Care Act insurance marketplaces relatively stable, the American Hospital Association (AHA) said in a comment letter. AHA asserts that should the...

HHS Approves Alaska 1332 Waiver for State Reinsurance Program

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Alaska will be able to move ahead with its plans to implement a state reinsurance program under a  1332 State Innovation Waiver, HHS confirmed this week.   The Alaska Reinsurance Program (ARP) will attempt to stabilize the...

CMS: Reinsurance, Risk Adjustment Programs Worked Well in 2016

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CMS has released the results from 2016 for reinsurance and risk adjustment transfers, two of the “three R’s” used to stabilize premiums in the Affordable Care Act (ACA) marketplaces.   This marks the third year the...

Healthcare Payers See Promise in Private Exchange Successes

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Private exchanges have grown in significance as a means for payers to get their products before employers, and their growth has resulted in increasing the number of health plan options for employees and beneficiaries. Additionally,...

CBO Score Finds 22 Million People Will Lose Health Coverage

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UPDATE: GOP Senators delayed the vote on the BCRA until after the July 4th congressional recess.  The Congressional Budget Office (CBO) released their revised cost estimate on the new ACA repeal bill, the Better Care and...

Balance Billing Hits Patients with Surprise Healthcare Costs

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Patients who received treatment within an in-patient network can still face surprise healthcare costs from balance billing. Balance billing occurs when an individual receives an unforeseen bill for treatment by an out-of-network provider,...

CMS Outlines Special Enrollment Period Rules for ACA Exchanges

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Starting on June 23, 2017, CMS will be enacting its new rules regarding special enrollment periods (SEP) for the ACA marketplace.  The agency released the new special enrollment rules earlier this year that will alter participation...

AMA, AHA Call for Stronger Patient Insurance Protections

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The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The move by eight of the nation’s...

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