Health Law
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Illinois stops Medicaid enrollment to state's BCBS
The state sanctioned the payer’s Medicaid managed care plan after it reportedly didn't meet patient access guidelines.
By Les Masterson • April 19, 2018
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3 states could have Medicaid expansion on the ballot
Meanwhile, Arizona is requesting a waiver to stop Medicaid recipients from getting retroactive coverage up to three months before a person applies for coverage.
By Les Masterson • April 18, 2018
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Insurers argue HHS must clamp down on dialysis patient steering
Payers and a major union group said CMS should reissue its rule on steering in the individual market to prohibit financially interested third parties from making insurance payments.
By David Lim • April 18, 2018
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ACA increased primary care usage, but also some risky behaviors, report finds
All of the gains in preventive care were driven by expansions in private insurance, according to the National Bureau of Economic Research paper.
By Meg Bryant • April 17, 2018
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New Jersey moves closer to its own individual mandate
The state legislature also approved a reinsurance program to help payers cover the sickest members. Both moves look to stabilize the individual market and ACA exchange.
By Les Masterson • April 16, 2018
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Short-term plan expansion will hike individual market premiums, lower enrollment
The Trump administration wants to expand short-term plans, also known as catastrophic plans, to anyone and increase their duration from three months to one year.
By Les Masterson • April 13, 2018
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UnitedHealthcare seeks arbitration to resolve Envision contract dispute
The payer has taken aim at Envision and even added a page to its website that names the company as a reason for "outsourced ERs" and higher ER costs.
By Les Masterson • April 11, 2018
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Medicaid improves access, preventive services, AHIP report says
The study comes as Virginia considers becoming the 34th state to expand Medicaid under the ACA.
By Les Masterson • April 11, 2018
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Feds boast $2.4B in healthcare fraud judgments, settlements
National healthcare fraud investigations are on the rise despite funding cuts to programs that investigate potential violations.
By Les Masterson • April 09, 2018
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Virginia bill giving NPs full practice rights awaits signature
Gov. Ralph Northam, a physician, has not indicated whether he’ll sign, amend or veto the bill that overwhelmingly passed the General Assembly.
By Les Masterson • April 04, 2018
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ACA plans expanded coverage for chronic conditions
Repeal of the individual mandate penalty, which goes into effect next year, will likely put the burden on states to figure out how to stabilize the ACA exchanges.
By Les Masterson • April 04, 2018
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Payers get better-than-expected Medicare Advantage rate increase
CMS also increased the role encounter data will play in determining risk scores and announced policies to target opioid abuse.
By Les Masterson • April 03, 2018
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States need more rules to protect individual insurance market
Changes made by the federal government may further destabilize the ACA exchanges, a new Commonwealth Fund report said.
By Les Masterson • April 02, 2018
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California sues Sutter for anticompetitive practices, high costs
The complaint alleges profits from Sutter's "illegal pricing practices" have gone toward acquisitions, executive wages and the financing of its own insurance arm.
By Tony Abraham • April 02, 2018
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Healthcare M&A leading to higher prices in California
A University of California, Berkeley study said northern California pays much higher healthcare prices than the southern part of the state.
By Les Masterson • March 28, 2018
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AHA argues HHS religious freedom rule unnecessary
The hospital group is also concerned that the proposed rule may endanger federal reimbursement if OCR takes action against a provider.
By David Lim • March 28, 2018
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UnitedHealth countersues feds in $1B MA suit
UnitedHealth asks for the government's lawsuit be dismissed with prejudice and seeks relief "in an amount to be determined at trial."
By David Lim • March 28, 2018
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HHS panel recommends testing 2 alternative palliative care payment models
Also, a new Health Affairs article explored the complexity of including hospice care in Medicare Advantage.
By Les Masterson • March 28, 2018
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Legislation looks to limit length of opioid prescriptions
The American Medical Association has called for more research on the topic and said prescription length depends on situation and type of care.
By Les Masterson • March 27, 2018
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Plans shirking ACA rules could spur more out-of-network care
Allowing health coverage to be sold across state lines could also limit oversight, a report by state regulators said.
By Les Masterson • March 27, 2018
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CMS mum on restricting how payers use subsidies
Insurers that offer ACA plans often use the practice of "silver loading," which involves putting all the losses associated with the end of CSR payments on only silver plans.
By Les Masterson • March 26, 2018
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Most employers short of tipping point for health coverage
The American Health Policy Institute predicted employers won't be rushing to drop health insurance as a benefit, but some will go that route in the face of unmanageable healthcare costs.
By Les Masterson • March 26, 2018
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Centene fined $100K for not fixing provider network inadequacies
The Washington state insurance commissioner says the payer has not adhered to its compliance plan following a $1.5 million fine last December.
By David Lim • March 23, 2018
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White House report targets health insurer profitability
The Council of Economic Advisers report argues many insurance companies' net profit margins have returned to pre-ACA levels on the backs of taxpayers.
By David Lim • March 21, 2018
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HHS makes case against hospitals' 340B suit in new filing
"Setting aside the final rule for 2018 would direct payments away from these other services while creating administrative havoc in the OPPS system," HHS argued in a court filing this week.
By David Lim • March 21, 2018