Policy and Regulation News

Eligibility, Cost Sharing Key Factors for Single-Payer Health Insurance

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Eligibility, cost sharing, and the role of private health insurance will be among the primary concerns for policymakers if they choose to design a single-payer health insurance system in the US,...

CMS Seeks New State Waivers to Boost Individual Insurance Market

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CMS is issuing a request for information (RFI) asking states for ideas to develop State Relief and Empowerment Waivers to reduce costs in the individual insurance market. In a recent blog post, CMS...

Sutter Health to Pay $30M in Medicare Advantage Settlement

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Sutter Health, a California-based, non-profit benefit organization, has agreed to pay $30 million to settle allegations that its affiliated entities submitted false information about the health status...

FTC Charges Surescripts with Monopolizing e-Prescribing Market

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The Federal Trade Commission (FTC) is suing Surescripts, alleging that the health information exchange company is using illegal vertical and horizontal restraints to maintain its monopoly over two key...

Large Employers to Average $3.6M on Wellness Programs in 2019

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Large employers across the country are expected to spend an average of $3.6 million on wellness programs in 2019 to support a healthier and more productive workforce, according to a survey from...

Short-Term Wellness Programs Not Impacting Healthcare Costs

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Short-term wellness programs prove useful in promoting positive health behaviors among employees, but these programs are failing to have a positive effect on healthcare costs, according to a study...

Majority of States Have Committed to Value-Based Care, Payment Reform

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There has been significant growth in the number of states and territories implementing value-based care models in the last five years, with a total of 48 committing to payment reform nationwide,...

HHS Charges Dozens in $1.2B Telemedicine, DME Fraud Scheme

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One of the largest healthcare fraud schemes investigated by the FBI and HHS and prosecuted by the Department of Justice resulted in $1.2 billion in losses and charges against 24 executives of...

$23.2B in Improper Payments Tied to Medicare Fee-For-Service Programs

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Documentation issues and other errors led to Medicare fee-for-service programs improperly paying $23.2 billion in 2017, a GAO report revealed. In comparison, Medicaid fee-for-service programs...

CMS Finalizes Medicare Advantage, Part D Payment Policies

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CMS has finalized new Medicare Advantage and Part D payment policies for 2020 that will increase competition among health plans, leading to higher quality care at lower costs.   The changes will...

Utilization Management Delays Cancer Care, Diminishes Outcomes

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Utilization management (UM) requirements are likely delaying cancer care and resulting in poorer outcomes for cancer patients, according to a survey conducted by Public Opinion Strategies and Hart...

Prevalence of Balance Bills Varies by State, Medical Specialty

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Certain states and medical specialties account for larger shares of out-of-network claims and balance bills for inpatient hospital admissions, according to a study conducted by the Health Care Cost...

Judges Strike Down Association Health Plans, Medicaid Work Requirements

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Several federal judges have decided that a number of signature Trump Administration health insurance policies cannot stand. Judges have nixed key efforts to expand the sale of association health plans...

CMS Launches Review Program for HIPAA-Covered Health Plans

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CMS has launched a Compliance Review Program to ensure that health plans, payers, providers, and other covered entities are complying with HIPAA Administrative Simplification rules for electronic...

Trump Administration Backs Scrapping Entire Affordable Care Act

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The Trump Administration is leaving no more ambiguity about its opposition to the entirety of the Affordable Care Act.  In a brief legal memo released this week, three Department of Justice...

New Jersey to Establish State Health Insurance Exchange

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New Jersey will move away from the federal insurance marketplace and transition to a state health insurance exchange in 2021, Governor Phil Murphy announced last week. The Democratic governor...

Emergency Air Ambulances Put Patients at Risk for Balance Billing

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Privately insured patients transported by emergency air ambulances outside their coverage networks are at high risk of balance billing, also known as surprise billing, according to a GAO report. Just...

Revised Tax Policies Needed to Reduce Individual Market Premiums

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Policymakers should revise current tax policies and work to eliminate financial barriers to health insurance in order to reduce individual market premiums, says a new brief from the Blue Cross Blue...

House Joins Senate in Urging Delay of Health Insurance Tax

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Democrats and Republicans from the House of Representatives have joined their Senate colleagues in introducing legislation to delay the ACA Health Insurance Tax for several years. Representatives...