Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

Virginia Legislature Approves Medicaid Expansion

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The Virginia General Assembly has passed Medicaid expansion as part of a two-year budget bill that could provide coverage to 400,000 newly eligible residents. The action would make Virginia the 33rd state in the US to expand Medicaid...

GAO Appoints Public Policy, Payment Experts to MedPAC

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The Government Accountability Office (GAO) has appointed five new public policy and healthcare payment experts to the Medicare Payment Advisory Commission (MedPAC). GAO chief Gene L. Dodaro, Comptroller General of the United States, is...

MN Law Allows Some Patients to Override Payers on Step Therapy

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Minnesota Governor Mark Dayton has signed a bill into law that allows patients and providers to execute overrides on payer step therapy programs for prescription drug treatments in certain clinical situations. HF 3196 requires payers to...

CMS: Medicare Part D Gag Clauses are “Unacceptable”

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CMS Administrator Seema Verma has stated in a letter to health plan sponsors that CMS will no longer tolerate Medicare Part D gag clauses as the federal agency continues to promote prescription drug price transparency for...

Commercial, Public Payer Healthcare Fraud Cases Total $21.6M

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The latest string of commercial and public payer healthcare fraud cases totaled $21.6 million from providers launching various schemes such as patient kickback agreements and false claims submissions. Public payer programs are frequently...

Payers Express Enthusiasm for Prescription Drug Pricing Reforms

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Healthcare payers and associated trade groups have expressed enthusiasm about President Trump’s proposed prescription drug pricing reforms.   A number of influential organizations have offered commentary on the plan, including...

More Competition May Benefit Medicare Advantage Bidding Process

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The Medicare Advantage (MA) bidding process requires more competition to increase the availability of high quality MA plans for beneficiaries and reduce federal spending, according to a new Brookings Institute report. Brookings analysts...

Managing Payer Challenges in the ACA Risk Adjustment Program

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The implementation of the Affordable Care Act risk adjustment program has created a number of challenges - as well as some promising opportunities - for payers participating in the ACA marketplaces.   Under the ACA, payers can only...

CMS Increases Payments for Durable Medical Equipment

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CMS has issued an interim final rule that raises Medicare payments for durable medical equipment (DME) to ensure Medicare beneficiaries have access to critical medical devices. The rule will raise DME payments to Medicare providers from...

CMS Approves Medicaid Work Requirements in New Hampshire

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CMS Administrator Seema Verma has approved New Hampshire's request to implement Medicaid work requirements and change additional Medicaid rules related to member eligibility.  The approval makes New Hampshire the fourth state to...

Verma: Patient Care, Payment Design Need Value-Based Reforms

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Changes to patient care and payment design are required to further the progress of value-based care reforms within the healthcare industry, said CMS Administrator Seema Verma in a speech to the American Hospital Association (AHA). During...

Former CMS Employee Found Guilty in Insider Trading Scheme

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A former CMS employee leaked high-level information related to the agency’s rulemaking decisions and changes in provider reimbursement as part of an insider trading scheme, according to a guilty verdict in the Southern District of...

Uninsured Rate among Working Adults Rises to 15.5% in 2018

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The uninsured rate of working adults ages 19 to 64 rose by more than 3 percent between 2016 and 2018, according to the Commonwealth Fund’s ACA Tracking Survey. In 2016, 12.2 percent of working adults lacked health insurance....

CMS Proposes Value-Based Payment for Skilled Nursing Facilities

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CMS has proposed to implement value-based payment reforms for skilled nursing facilities (SNFs) and other Medicare inpatient facilities in order to reduce fraud and create higher quality healthcare experiences for beneficiaries. The...

CMS Releases Medicare Advantage Encounter Data to the Public

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CMS has planned to release Medicare Advantage encounter data so that researchers and consumers have the ability to make informed opinions about the cost and healthcare outcomes of the MA program. The agency will allow researchers to...

Short-Term Health Plans Lack Mental Health, Prescription Benefits

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Short-term health plans generally lack mental health and prescription drug benefits and may create financial-based health insurance barriers for unhealthy beneficiary populations, according to a Kaiser Family Foundation (KFF)...

CMS Aims to Catalyze Advancements in Consumer Price Transparency

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A proposed rule that requires hospitals to post their standard service rates online is only the start of CMS efforts to advance consumer price transparency across the entire agency, according to CMS Administrator Seema Verma. Verma...

CMS Rule Ups Medicare Hospital Payments, Cuts Quality Measures

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CMS has proposed a new federal rule that increases overall Medicare hospital payments while removing 19 quality measures in efforts to lower administrative burden to Medicare providers. The rule would also increase price transparency and...

AHIP Calls for Changes in Proposed Association Health Plan Policy

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AHIP has issued a statement to CMS that calls for changes in the agency’s proposed rule on association health plan (AHP) and short-term plan policy to avoid unintentional disparities in health insurance access for individuals with...

Payers, Orgs Provide Feedback on CMS Value-Based Care Reform

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CMS has received over 1,000 comments from healthcare payers and expert organizations that suggest the agency’s efforts to implement value-based care reform will require changes to provider accountability, chronic disease management,...

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