Despite having access to health benefits, 40 percent or more of United States citizens have difficulty affording their prescription drugs.
A GoodRx survey of 1,060 respondents about their...
A new report on Medicare telehealth between 2014 and 2016 shows increased utilization of telehealth services by Medicare beneficiaries but largely remains an untapped resource because of restrictive...
Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health...
New research published by the Kaiser Family Foundation provides insight into the forces driving health payers to participate in certain ACA marketplaces while wholly quitting others.
Insurer...
Medicaid beneficiaries with mental health conditions are the targets of recent CMS efforts to boost health outcomes.
In recent remarks to the National Association of Medicaid Directors in the national...
Medicaid beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED) are the targets of recent CMS efforts to improve health outcomes.
In a letter to Medicaid directors...
Health insurance open enrollment’s kicked off, accompanied by a spike in automated calls with offers of Affordable Care Act or other health plans, much to the chagrin of...
CMS has proposed a new rule to reduce regulation around Medicaid managed care programs and allow states to contract with private payers to deliver managed care at faster rates.
CMS developed the rule...
CMS has proposed a new rule that would audit premium subsidy eligibility for individual health plan beneficiaries and monitor premium assistance programs through the federal insurance exchanges.
The...
Federal judges for the US Federal District Court of Appeals denied a request to reopen a case that could provide over $12 billion in risk corridor payments to payers.
Moda Health Plan, BlueCross...
CMS has proposed a new rule that would recalculate Medicare home health payments using a case mix payment model.
In 2020, the agency plans to implement the Patient-Driven Groupings Model (PDGM)...
CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers.
The...
A new drug pricing model with an international component could save Medicare Part B approximately $17.2 billion over five years, CMS says.
The International Pricing Index (IPI) will test if...
The Departments of Labor, Treasury, and HHS have proposed a new rule that would allow employers to directly reimburse employees’ care costs through health reimbursement arrangements (HRAs) as an...
CMS has issued federal guidance intended to expand the scope and availability of state-level waiver programs.
State governments can now apply for State Relief and Empowerment Waivers that may...
New high-profile Medicare fraud cases have led to convictions and lengthy prison sentences for providers that attempted to defraud Medicare of $36.9 million.
Federal agencies including HHS, the FBI,...
CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans.
The agency stated that it is the first time...
The American Medical Association and other industry trade groups have filed amici curiae in support of a lawsuit contesting the legality of short-term health plans.
The Association for Community...
Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from...
CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA...
