As the 5th Circuit deliberates whether the Affordable Care Act is constitutional — particularly the severability of individual mandate to acquire essential coverage — here are some of the...
On July 11, CMS proposed a rule that would start the transition to value-based payment in the home healthcare field and make a home infusion benefit available to Medicare...
CMS is proposing to relax rules requiring states to submit and update Medicaid access monitoring review plans, which would largely leave states in charge of ensuring adequate Medicaid beneficiary...
On Thursday, the White House backed down from its proposed rule that would have prohibited pharmacy benefit manager rebates because the rule would have raised seniors’ premiums and Medicare...
CMS recently released a summary report of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year, asserting in the report that the data proves the program acted as intended...
CMS recently approved two section 1115 demonstration waivers that will allow Minnesota and Nebraska to improve and expand upon their Medicaid institutions for mental diseases (IMDs) over the course of...
President Trump’s regulation requires healthcare price transparency on treatment costs and price negotiations, the White House announced in a press release on Monday
“To make fully...
A new rule from CMS calls for electronic prior authorization (ePA) updates, aiming to improve prescribers’ decision-making processes, ease administrative burden, and decrease the wait time for...
The Centers for Medicare & Medicaid Services (CMS) released renewed guidance on Medicaid eligibility determinations and spending integrity the organization announced.
According to CMS, Medicaid...
On June 14, Texas joined the ranks of a score of states with consumer protections against surprise billing (or balance billing) with the signing of Senate Bill 1264.
Effective this September, the bulk...
The finalized rule on health reimbursement arrangements (HRAs) contains two major changes compared to its earlier version.
Employers will be permitted to provide HRAs that are integrated with...
Mergers and acquisitions are commonplace in healthcare, but leading payers in the United States claim provider consolidation is costing consumers.
In testimony submitted to the Senate Subcommittee on...
The Trump Administration issued an executive order that will allow employers to help employees pay for health insurance via health reimbursement arrangements.
As part of individual coverage health...
The healthcare payer and insurance industry are key drivers of state economies across the country, not only by expanding access to care and payer coverage, but by creating jobs for millions of...
Connecticut State Comptroller Kevin Lembo confirmed midweek that proposed legislation to establish a public option in the state is dead following resistance from major payers.
One payer, in...
Before members of Congress retired for the long weekend, leaders of the Senate Committee on Health, Education, Labor and Pensions (HELP) unveiled draft legislation for the Lower Health Care Costs Act...
Reducing the costs of certain diagnostic tests could result in cost savings totaling at $18 billion annually, according to a report from UnitedHealth Group.
Currently, the healthcare industry is...
Legislation to address surprise medical bills must center on the patient, protecting patients from having to take part in mitigating extraordinarily high medical bills.
Such was the conclusion of a...
CMS and state Medicaid agencies are not always transparent about the consequences of 1115 demonstration waivers, specifically about how various demonstrations might impact beneficiaries, according to a...
New guidance from CMS addresses the issue of prescription drug price spreading and reiterates Medicaid and CHIP managed care program obligations to account for the practice when calculating certain...
