Health Law
-
Supreme Court to hear $12B risk corridor case next term
The Chamber of Commerce urged the court to take the case, warning that if the government is allowed to renege on its promised payments it could scare off the business community from working with the government.
By Dana Elfin • June 25, 2019 -
Court says CVS exec's move to PillPack violated noncompete
Jefferies analysts said the case documents show Amazon is seeking to bypass pharmacy benefit managers and contract directly with payers for its services, a negative signal for the PBM industry.
By Dana Elfin • June 20, 2019 -
Senators differ on best approach to ban surprise billing
Senate HELP Committee Chairman Lamar Alexander, R-Tenn., seemed to support a guarantee that any care received at an in-network facility would be covered by a patient's insurer, a measure opposed by the provider lobby.
By Rebecca Pifer • UPDATED: June 19, 2019 at 1:41 p.m. -
Trump admin opens door to fundamental changes in healthcare benefits
Paul Fronstin of the Employee Benefit Research Institute said he doesn't expect a ton of uptick right away, but when the next recession hits, "the future of health benefits gets put to the test."
By Samantha Liss • June 17, 2019 -
MedPAC urges MA data, primary care reforms
Included in the recommendations to Congress are changes to slow the growth of ER spending in Medicare fee-for-service.
By Samantha Liss • June 14, 2019 -
House votes to overturn decades-old ban on national patient identifier
Industry cheered the first step in repealing the 23-year-old ban, with NextGate CTO Dan Cidon saying it will "move the needle" on interoperability.
By Rebecca Pifer • June 14, 2019 -
Influential panel urges HIV prevention drug, forcing payer hands
The task force charged with making clinical recommendations is advising those at high risk of contracting HIV take a daily medication to prevent the disease, which will likely expand access to the treatment.
By Samantha Liss • June 12, 2019 -
Congress warns industry to hurry on surprise billing fix
"If you don't solve the problem, then we will solve the problem and none of you will like it," Rep. Michael Burgess, R-Texas, told payer and provider reps testifying Wednesday.
By Rebecca Pifer • June 12, 2019 -
In win for hospitals, Supreme Court rules DSH change violated law
The nation's highest court, in a 7-1 opinion, vacated an HHS policy that would have cut reimbursement to hospitals with high shares of low-income patients, saying the government did not follow proper procedures in issuing the policy.
By Dana Elfin • June 03, 2019 -
Provider groups slam rate setting in House surprise billing draft legislation
Health systems and other providers worry if rate setting is enacted it will become the default payment for healthcare services and hurt their bottom lines.
By Rebecca Pifer • May 30, 2019 -
Show me the evidence, judge tells short-term health plan rule challengers
The government and patient advocate groups faced off in court over a final rule expanding access to short-term health insurance plans. A ruling is not expected until later this summer.
By Dana Elfin • May 22, 2019 -
5 state AGs push judge to approve CVS-Aetna merger agreement
The states originally opposed the deal but said they are satisfied with the current merger agreement.
By Samantha Liss • May 20, 2019 -
FTC commissioner: M&A outpacing agency funding
The regulator and other enforcers face multiple challenges in bringing enforcement actions against hospitals, FTC Commissioner Rebecca Kelly Slaughter said.
By Dana Elfin • May 15, 2019 -
Payers not entitled to $12B in risk corridors payments, DOJ says
According to a claim filed by government officials Wednesday, the Trump administration doesn't have to shell out the funds because Congress required the Affordable Care Act to be budget-neutral.
By Rebecca Pifer • May 10, 2019 -
States inch forward on nurse staffing laws
A mandatory staffing bill is gaining steam in Illinois, a lawmaker reintroduced federal staffing legislation and a number of states are studying the potential impact of what unions call "safe staffing limits."
By Tony Abraham • May 10, 2019 -
Payers had best individual market performance in 2018 since ACA began
A Kaiser Family Foundation analysis on the profitability of the ACA individual market also found insurers expect to pay a record amount of rebates to consumers for not meeting the medical loss ratio threshold in 2018.
By Rebecca Pifer • May 08, 2019 -
Trump administration asks appeals court to toss entire ACA
DOJ urged the Fifth Circuit to uphold a trial court's ruling finding the law unconstitutional, marking a change for the government, which had previously said the remainder of the ACA was severable from its individual mandate.
By Dana Elfin • May 02, 2019 -
CMS seeks comments on state workarounds to ACA requirements
The agency has gradually pushed states to consider more so-called innovation waivers that can allow them to sidestep key tenets of the ACA in their health insurance markets.
By Rebecca Pifer • May 02, 2019 -
UPMC case against state AG dismissed
The health system had alleged the state overstepped its authority in attempts to force the organization to contract with its rival Highmark.
By Samantha Liss • April 26, 2019 -
Surprise billing, drug rebates among likely reforms this year, S&P Global says
ACA repeal efforts and "Medicare for All," however, have little chance of advancing in the current political landscape, according to a new report.
By Meg Bryant • April 22, 2019 -
More than 50 medical professionals indicted in federal opioid cases
HHS also said it has excluded more than 2,000 people from participating in Medicare, Medicaid and other federal healthcare programs for opioid diversion and abuse activity since June 2018, including more than 650 providers.
By Les Masterson • April 18, 2019 -
Healthcare again tops industries for cybersecurity attacks, data breaches
Breach notifications triggered 34 investigations by the HHS Office for Civil Rights in 2018, up from 22 the previous year.
By Meg Bryant • April 11, 2019 -
DOJ indicts 24 people in $1.2B healthcare fraud scheme
The defendants include CEOs and COOs of five telemedicine companies, the owners of dozens of durable medical equipment companies and three licensed medical professionals.
By Les Masterson • April 10, 2019 -
CMMI asks for ideas on post-acute care payment model at AHA annual meeting
The head of the CMS innovation arm told hospital leaders Monday his agency is in listening mode, looking for ways to lower costs and improve quality in post-acute care.
By Samantha Liss • April 09, 2019 -
CVS-Aetna judge to hear testimony from critics next month
The American Medical Association is expected to be among the witnesses called as the federal judge tasked with approving the merger agreement between the companies and the DOJ drags out his review.
By Samantha Liss • UPDATED: April 23, 2019 at 5 p.m.
