Health Law
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Partial Medicaid expansion would restrict access for near-poor adults, study finds
Wisconsin is the only state so far to partially expand the program, but at least three other states are considering such a proposal, according to a Center on Budget and Policy Priorities report.
By Les Masterson • Aug. 15, 2018
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Nearly 20% of inpatient admissions include out-of-network charge
A Kaiser Family Foundation report found the issue of surprise billing is especially problematic for care in ERs and for psychological or substance abuse treatment.
By Les Masterson • Aug. 14, 2018
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AHA continues to push HHS on Medicare billing backlog
AHA and three member hospitals are suing the agency and in the latest court filing suggested methods for reaching a court-ordered 2020 deadline for getting through the claims.
By Les Masterson • Aug. 14, 2018
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Cigna wins Texas underpaid claims lawsuit
North Cypress Medical Center charged that the payer owed $50 million in unpaid claims, but Cigna said the hospitals's fee-forgiving policy for out-of-network care is illegal.
By Les Masterson • Aug. 10, 2018
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CMS to allow step therapy in MA plans in bid to boost price competition
Dan Best, CMS senior advisor for drug pricing reform, told reporters the policy could save 15-20% of the $12 billion annual spend by MA plans on oft-pricey Part B drugs. Not all analysts buy that estimate.
By David Lim • Aug. 08, 2018
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States sue Trump administration over AHP expansion
Critics fear that by tempting people with lower-cost offerings, AHPs and catastrophic plans could cause millions to flee the ACA exchanges.
By Les Masterson • July 30, 2018
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CMS reinstates ACA risk-adjustment payments
The agency said a final rule reviving the program will go into effect immediately because it "is imperative to maintain stability and predictability in the individual and small group health insurance markets."
By Rebecca Pifer • July 25, 2018
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State individual mandates would boost coverage, curb premiums
The Commonwealth Fund reported there would be more than 7 million fewer uninsured people in 2022 if all states implemented individual mandates.
By Les Masterson • July 23, 2018
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CMS re-opens Kentucky Medicaid work mandate comment period
The move comes after a federal judge rejected the agency's approval of a waiver for the state.
By Tony Abraham • July 20, 2018
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ACA Medicaid pay boost didn't lure docs, JAMA study says
Possible reasons for this lack of interest were delayed payments, a finite timeframe and documentation requirements to qualify.
By Les Masterson • July 18, 2018
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Anthem sued by doc groups over ED policy
American College of Emergency Physicians President Paul Kivela called the policy dangerous in expecting patients to know the difference between minor or potentially life-threatening conditions.
By Les Masterson • July 17, 2018
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AHA 340B lawsuit denied by federal appeals court
The hospital industry lost its legal challenge to the Trump administration's cuts to the 340B drug pricing program, with a three-judge panel ruling AHA failed to meet certain necessary "presentment" requirements.
By Tony Abraham • July 17, 2018
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Major payers unlikely to see financial hit from risk-adjustment halt, Fitch says
But the decision to halt the payments is likely to destabilize the individual market, according to the ratings agency.
By Les Masterson • July 16, 2018
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HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care
A new report found that not all managed care organizations use proactive data analysis or inform states when providers are suspected of abuse.
By Les Masterson • July 13, 2018
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ACA plan member costs increasing, networks narrowing, study says
Avalere, which conducted the report for the Physicians for Fair Coverage, said restricted networks are resulting in more out-of-network care and surprise billing.
By Les Masterson • July 12, 2018
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States looking to courts in fight against ACA
Twenty states are arguing the ACA's mandate that most people have health insurance is unconstitutional because the penalty for noncompliance will be zeroed out starting next year.
By Les Masterson • July 09, 2018
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Florida practitioners agree to pay $1.7M to resolve false claims case
FWC Urogynecology reportedly used Medicare billing codes to inflate payments.
By Les Masterson • July 06, 2018
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Los Angeles psychiatric facility settles patient dumping case
Silver Lake Medical Center will create new policies for discharging homeless patients and give $550,000 to fund a new Homeless Patient Assistance Program.
By Les Masterson • July 05, 2018
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CMS: Unsubsidized ACA enrollment dropped 20% in 2017
The agency used new data to make their case that federal and state-based exchanges and state individual health insurance markets are in turmoil.
By David Lim • July 03, 2018
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Drug, device companies gave docs, teaching hospitals $8.4B in 2017
The amount includes $2.82 billion for non-research payments, such as meals, fees and travel to speaking events.
By Les Masterson • July 03, 2018
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CMS pitches MA demo letting doctors avoid MIPS rules
Administrator Seema Verma said the pilot looks to "put Medicare Advantage on a more equal playing field with fee-for-service Medicare.”
By Les Masterson • July 02, 2018
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Payment reform must keep patient equity in mind, consumer group says
A Families USA report urges shifting to a payment system that recognizes population health efforts, rewards value and addresses inequities.
By Les Masterson • July 01, 2018
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GAO: 340B hospitals, contract pharmacies need more oversight
Republicans say the watchdog report is the latest example that changes are needed to ensure the program's integrity.
By David Lim • June 29, 2018
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CMS clears Medicaid value-based drug state plan, denies closed formulary
The agency also made clear that drugs approved by the FDA under its accelerated approval pathway must be covered by state Medicaid programs if they are defined as a "covered outpatient drug."
By David Lim • June 28, 2018
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CMS to step up scrutiny of state Medicaid programs
MLR audits will focus on states "based on the amount spent on clinical services and quality improvement versus administration and profit."
By David Lim • June 27, 2018