Policy and Regulation News

Problems with Medicare Advantage Payment System Contribute to Overpayment

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The Medicare Advantage program has serious structural problems that lead to overpayment and policymakers must take action on MedPAC’s recommendations in order to create a more cost-effective...

HHS Procures Federally-Covered COVID-19 Treatment Doses For Uninsured

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The US Department of Health and Human Services (HHS) will cover doses of the coronavirus monoclonal antibody treatment bebtelovimab for the uninsured and underinsured, the department...

40% of Americans Blame Deductibles for High Out-of-Pocket Healthcare Costs

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Member experience in the US healthcare system is fraught with challenges, but there are steps that policymakers can take to reduce out-of-pocket healthcare costs and make navigation more amenable,...

OR Introduces Coverage for Mental Health Mobile Crisis Intervention Services

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The US Department of Health and Human Services (HHS) has approved a proposal from Oregon’s Medicaid program, Oregon Health Plan, to cover community-based substance abuse and mental healthcare...

Consumers Seek Transparency Around Treatment Costs, Healthcare Deals

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Consumers voiced their support for more transparency around healthcare costs and deals, with three-quarters of respondents supporting protections against site-based treatment cost increases in an AHIP...

Total Medicaid Expansion Could Improve Uninsurance, Heath Equity

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If the 12 states that have not yet expanded Medicaid eligibility adopted Medicaid expansion and the US achieved total Medicaid expansion, they could provide access to healthcare coverage for 3.7...

Payers Praise Inflation Reduction Act, Warn About Pharmaceutical Loopholes

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When the Senate passed the Inflation Reduction Act on August 4, 2022, payers and payer organizations met the proposed law with largely positive reactions, though some payer groups pointed out areas...

Cementing ARPA Enhanced Subsidies May Boost Deficit, Lower Uninsurance

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Making the American Rescue Plan Act of 2021’s enhanced subsidies permanent would increase the federal deficit by over $247 billion over nearly a decade, according to a letter from the...

Key Factors in 2023 Individual Health Insurance Market Premiums

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As payers finalize premiums for 2023 for the individual market, 2023 individual health insurance market premiums will be subject to a variety of factors, according to an issue brief from AHIP. The...

NY Anticipates the Impact of Ending the American Rescue Plan Act Flexibilities

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The American Rescue Plan Act established enhanced tax credits that boosted New York’s state health insurance marketplace enrollment, but the end of those tax credits could lead to a spike in...

Reducing Premiums Can Lead to Improved Insurance Coverage

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The elimination of small premiums could lead to better coverage, lower costs, and more effective retainment of consumers, according to research from the USC-Brookings Schaeffer Initiative for Health...

GAO: Gaps Remain in Medicaid Managed Care Direct Payments Oversight

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Despite CMS efforts to expand oversight of Medicaid managed care direct payments and the US Government Accountability Office’s (GAO’s) previous recommendations to improve processes, the...

Colorado Implements Section 1332 Waiver to Advance Health Equity

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The US Department of Health and Human Services (HHS) has approved the “Colorado Option,” a Section 1332 state innovation waiver amendment intended to address health equity in the Centennial...

Key Steps to Improve Coverage Integration for Dually Eligible Individuals

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In its June 2022 report to Congress, MACPAC laid out ways that states can improve the integration of Medicare and Medicaid coverage for dually eligible individuals. “Fully integrated models are...

HHS, CMS Extend American Rescue Plan Funding For HCBS Another Year

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The US Department of Health and Human Services (HHS) and CMS announced that states will have another year to invest American Rescue Plan funds in home- and community-based services (HCBS). “The...

BMA Supports Bill on Medicare Advantage Prior Authorizations

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Better Medicare Alliance (BMA) has endorsed HR 3173, the Improving Seniors’ Timely Access to Care Act, a law that seeks to reform prior authorization in Medicare Advantage. “When it comes...

NQF Opens Comment Period on Federal Program Quality Measures

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The National Quality Forum (NQF) has launched a comment period related to quality measures in federal programs. “Conducting a thoughtful review of performance measures used in federal programs...

CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

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CMS and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, which includes standardized plan options, changes to network adequacy...

Part D Out-of-Pocket Spending Cap Could Promote Health Equity

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Applying an out-of-pocket spending cap to Medicare Part D could be a tool for promoting health equity, according to an insight from Avalere. Avalere researchers leveraged 2019 Medicare Part D Drug...

AHIP Responds to Proposed CDC Opioid Prescribing Guidelines

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AHIP has responded to the latest updates to opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC). CDC’s proposed updates to the opioid prescribing guidelines...