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Policy and Regulation News

Senate Bill Proposes Medicare Health Plan for All Ages

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Senator Jeff Merkley (D-OR), with sponsorship from 11 other Democrats, has introduced a bill to create a Medicare health plan for all ages that would be offered in state and federal health exchanges, as well as the employer-sponsored...

HHS Appoints James Parker to Address Health Insurance Costs

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HHS Secretary Alex Azar has appointed James Parker as Senior Advisor to the Secretary of the Office of Health Reform to address healthcare challenges related to health insurance costs and health plan availability. Parker previously served...

DoJ Settles $27.68M in Medicare Fraud, False Claims Act Violations

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The Department of Justice continues its crackdown on Medicare fraud by settling various criminal cases related to $27.68 million of False Claims Act violations. Provider settlements remain the primary medium for healthcare fraud...

How Payers Can Succeed in Association Health Plan Markets

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Association health plans (AHPs) may completely alter the nation’s health insurance markets with increasing support from federal entities and a handful of state insurance commissions. An expansion of the AHP market may materialize...

Maryland Creates State Reinsurance Program to Control Premiums

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Maryland governor Larry Hogan has signed legislation to create a state reinsurance program aimed at stabilizing health plan premium increases. The reinsurance program will use state and federal reinsurance funding to pay catastrophic...

CMS Relaxes Affordable Care Act Health Plan Regulations

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CMS has issued a final rule that relaxes certain Affordable Care Act health plan regulations in an effort to drive competition and affordability within state health insurance markets. The agency said that the new rule will give payers...

Experts Support Medicaid Work Requirements Lawsuit Against KY

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A lawsuit that contends the legality of Medicaid work requirements in Kentucky has received support from 43 public health experts and 8 medical school deans who say the work requirements directly violate the Medicaid program. In an amicus...

GAO Finds Several Medicare Beneficiary Data Vulnerabilities

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CMS may have significant Medicare beneficiary data vulnerabilities because of security standards gaps within organizations that review and audit Medicare performance, a new GAO report found. GAO found security risks based on discrepancies...

11.8M Members Bought Health Plans Via Affordable Care Act Exchanges

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Nearly 11.8 million beneficiaries have enrolled or re-enrolled in a health plan through the Affordable Care Act exchanges, reaching close to 2017 enrollment totals (12.2 million) despite federal changes in how the exchanges are funded and...

Rising Medical Costs Created Health Plan Enrollment Shifts in MN

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The Minnesota of Council of Health Plans (MCHP) associated rising beneficiary medical costs in 2017 to irregular health plan enrollment shifts in both the private and public market. The Council said in a press release that a three percent...

CMS Final Rule Aims to Lower Medicare Prescription Drug Costs

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CMS is planning to lower Medicare prescription drug costs through a final rule that allows members to purchase less expensive biosimilars and generic drugs and increases the potential value of Medicare Advantage (MA) and Part D plans. CMS...

OIG: Medicaid Fraud Control Units Recovered $1.8B in 2017

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Medicaid fraud control units (MFCUs) recovered $1.8 billion in 2017 through effective collaboration with state governments, according a new report released by the Office of the Inspector General (OIG). MFCUs recovered $6.52 for every...

Iowa Gov. Approves Expansion of Association Health Plans

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Governor Kim Reynolds has signed a bill that will allow small groups and agricultural associations to create association health plans (AHP) that operate outside of the individual health plan market. Senate File 2349 requires associations...

Proposed Rule Deregulates Medicaid Managed Care, Fee-for-Service

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CMS has proposed a new rule that deregulates certain aspects of Medicaid managed care and Medicaid fee-for-service (FFS) programs in order to reduce regulatory burdens at the state level. The rule would exempt managed care programs from...

AL Medicaid Work Requirements Linked to Health Equity Challenges

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Alabama’s proposed Medicaid work requirements are likely to lead to health equity challenges by inadvertently creating eligibility barriers for vulnerable populations, according to research from the Georgetown Health Policy...

Payers Will Face Individual Health Plan Market Challenges in 2019

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Payers participating in the individual health plan market will face challenges in 2019 based on the planned expansion of association health plans (AHPs), increased competition, and changing provider negotiations, according to the Urban...

Proposed Legislation May Lower Individual Premiums by 40%

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Senator Lamar Alexander (R-TN), Senator Susan Collins (R-ME), House Energy and Commerce Committee Chairman Greg Walden (R-OR) and Representative Ryan Costello (R-PA) have proposed legislation that aims to lower individual health plan...

Tavenner Steps Down from AHIP, Hands Leadership to Matt Eyles

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The AHIP Board of Directors has appointed Matt Eyles as the organization’s new President and CEO to replace Marilyn Tavenner after she retires on June 1st, 2018.    Eyles was elected unanimously as Tavenner’s...

Individual Insurance Premiums to Soar Without Policy Actions

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Individual insurance premiums may rise between 12 and 32 percent nationally by 2019, with cumulative increases of 34 to 94 percent by 2021, according to new research conducted by health plan actuaries and experts at Harvard, UCLA, and UC...

CMS: Idaho Association Health Plan Expansion Violates ACA

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CMS Administrator Seema Verma informed Idaho governor C.L. “Butch” Otter (R-ID) and state insurance officials that efforts to launch an expansion of association health plan (AHPs) sales violates the market protections...

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