Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

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 garner...

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 $1.3...

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 Price.  ...

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 government...

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 state’s...

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 agency...

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, the expanded...

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 Reconciliation...

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, even...

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 criteria...

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 leading...

Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan

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If Iowa’s health insurance exchanges are completely abandoned, the state will request that the federal government allow the establishment of a state health care plan for 2018. If approved by CMS, the stopgap measure would create the Iowa...

Nevada Legislature: All Residents Should Have Medicaid Access

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The Nevada State Assembly has passed a bill which would open Medicaid enrollment to all of the state’s residents, regardless of income or health status.   The Nevada Care Plan would allow every state resident without health insurance...

AHCA CBO Score Predicts 23M Uninsured, Higher Out-of-Pocket Costs

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The CBO report on the American Health Care Act (AHCA) found the bill would result in 23 million people losing insurance coverage over the next decade.  Other impacts of the bill include higher out-of-pocket costs for most patients and significant...

WA Health Insurance Exchange In Flux With CSR Confusion

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Washington State has thus far been a success for the health insurance exchange marketplace.  The state has seen robust payer participation, increased enrollment and a trend-bending eight percent benchmark premium increase in 2017, versus...

650 Medical Groups Sign On to Abolish Medicare Budget Panel

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Over 650 medical organizations have signed a letter to Congress from the Healthcare Leadership Council (HLC) supporting the elimination of the Independent Payment Advisory Board (IPAB).  The HLC joins a chorus of support for two bipartisan...

CMS Offers Resources for High-Risk Pools, Reinsurance Waivers

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The Centers for Medicare and Medicaid Services (CMS) has just released a checklist for states to use on applications for Section 1332 waivers.    The waivers are specifically targeted at helping states establish high-risk pools...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the nation’s patients. ...

Maine Medicaid Waiver Would Increase Patient Responsibility

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Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s proposed changes...

BCBS Moves into Vacant TN Health Insurance Exchange

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Blue Cross-Blue Shield (BCBS) has announced its plans to offer coverage options on Tennessee’s Affordable Care Act health insurance exchange in 2018.  The separate rating area consists of 16 counties in the greater Knoxville area....

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