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Public Payers News

CMS Proposes Medicare Home Health Agency Payment Changes

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CMS proposed Medicare home health agency payment changes in a new rule intended to reduce provider burdens and advance flexible, transparent payment models in the next two years. “CMS is committed to helping patients and their...

CMS to Host Summit on Behavioral Health Payment, Care Delivery

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CMS has opened registration for a one-day summit where healthcare experts can discuss ideas about innovative behavioral health payment models and related care delivery systems. The Behavioral Health Payment and Care Delivery Summit will...

Medicare Hospital Insurance Trust Fund Depleted by 2029

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A statement released by HHS and CMS’s Medicare Board of Trustees (MBT) indicates that the Medicare Hospital Insurance Trust Fund is likely to be depleted by the year 2029. The report suggests that the difference between Medicare...

Medicaid Beneficiaries Satisfied with Coverage and Access

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A recent Harvard Chan School of Public Health analysis found that Medicaid beneficiaries are overwhelmingly satisfied with their coverage and access to providers.  The nationwide survey of more than 60,000 beneficiaries also evaluated...

Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut

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A significant rollback of Medicaid coverage in Tennessee has led to a spike in late stage diagnosis for breast cancer, according to a new data analysis published in the American Cancer Society journal Cancer. The research team led by...

Texas Requests Medicaid Waiver Extension for $6.2 Billion

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Although Texas refused federal funds in the 2014 ACA Medicaid expansion, it has recently submitted documents requesting its second Medicaid waiver extension for $6.2 billion.   Originally approved in 2011, the 1115 Medicaid...

CMS Uses Gender, Race For Quality of Care Medicare Study

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The CMS office of Minority Health released a report with data on the quality of care received by Medicare Advantage (MA) enrollees by gender in four ethnic or racial categories.  The data generated by these reports was not used to...

Cigna Re-enters Medicare Advantage Market With CMS Approval

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Cigna announced in a securities filing that it had received the green light from CMS to begin offering Medicare Advantage plans again after an 18 month suspension.  The insurer had been banned from offering the popular Medicare...

Flexibility and Innovation Needed To Control Medicaid Costs

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As state and federal regulators debate the future of Medicaid spending, health researchers have identified the need for flexibility and innovation in Medicaid policies involving payment models, delivery of care and drug costs. The...

Medicaid Enrollment a “Lifeline” for Rural Residents, Children

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Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children...

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

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Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

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Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our...

Two Payers Liable for $32.5M in Medicare Advantage Fraud Suit

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Insurers Freedom Health and Optimum Healthcare have agreed to pay $32.5 million to avoid further litigation in a whistleblower lawsuit which alleges systemic Medicare Advantage fraud.    The insurers will pay the federal...

Single-Payer Healthcare Plan May Cost California $400 Billion

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California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway...

Understanding the Basics of Accountable Care Organizations

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Accountable care organizations (ACOs) are provider-based networks which utilize data analytics and population health management strategies to increase efficiency, improve patient outcomes, and reduce healthcare costs. Originally...

WI Medicaid Waiver Adds Drug Testing, Behavior Incentives

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The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries. The...

CMS Adds Stricter Health Insurance Exchange Enrollment Rules

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Slated to begin in June 2017, the Centers for Medicare and Medicaid Services (CMS) will be rolling out a pilot program aimed at tightening scrutiny of those using the special enrollment period on the ACA health insurance exchanges. The...

Two-Thirds of Physicians Disapprove of American Health Care Act

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Two-thirds of physicians in a new Merritt Hawkins survey reported having a negative impression of the American Health Care Act (AHCA).  This includes 58 percent of physicians who have a “strongly” negative take on...

Cardiologists: Senate Must Ensure “Meaningful Insurance Coverage”

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In a letter sent to Senate leadership, American College of Cardiology President Mary Norine Walsh, MD, advised lawmakers to ensure access to “meaningful insurance coverage and quality, cost-effective care” for the...

Maine Medicaid Waiver Would Increase Patient Responsibility

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Maine will apply for a Section 1115 Medicaid waiver from the Centers for Medicare and Medicaid Services (CMS) to be granted flexibility to circumvent federal regulations and impose reforms on its Medicaid program. The state’s...

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