Policy & Regulation
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The White House/Healthcare Dive, data from WhiteHouse.gov
Trump health plan called 'pixie dust' on pre-existing conditions, builds on transparency bid
Despite talk by President Donald Trump to preserve pre-existing condition protections, his administration has undermined those protections through litigation and policy decisions.
By Hailey Mensik • Sept. 25, 2020 -
Getty
Experts seek answers on why few Medicaid providers sought COVID-19 relief
Just $2.2 billion of the $15 billion set aside has been paid out as of Sept. 11, a presentation by MACPAC staff found. Commissioners asked if a deadline should be reopened.
By Samantha Liss • Sept. 25, 2020 -
Trendline
Social determinants of health
The focus on social determinants of health has only increased as the COVID-19 pandemic has devastated the United States.
By Healthcare Dive staff -
Fotolia
CMS touts dip in Medicare Advantage premiums for 2021
SVB Leerink analysts point to Centene, Humana and UnitedHealthcare as payers best positioned to pick up more share next year.
By Samantha Liss • Sept. 25, 2020 -
Getty Images
Biden preferred over Trump on COVID-19, pre-existing conditions, poll finds
Those younger, Black and Hispanic were more likely to list the pandemic as the top concern while older and White voters choose protecting health insurance coverage, The Commonwealth Fund survey found.
By Shannon Muchmore • Sept. 24, 2020 -
Fotolia
Primary care docs call for federal aid as 1/3 still face significantly low revenue
The new weekly survey from the Larry A. Green Center and Primary Care Collaborative shows a slightly rosier snapshot for primary care providers but suggests trouble ahead amid zero action from Congress and the flu season.
By Rebecca Pifer • Sept. 23, 2020 -
Opinion
Medicare Advantage should not 'game the system' but prioritize patient care, honest billing
The HHS Office of Inspector General's principal deputy warns, "My office and other government agencies are targeting oversight to make sure plans do not pad risk adjustments with unsupported diagnoses."
By Christi A. Grimm • Sept. 23, 2020 -
Payers, other stakeholders urge Congress to blunt COVID-19-spurred insurance losses
"The odds are we are on track to having the greatest coverage losses we've ever recorded," Stan Dorn, director of the National Center for Coverage Innovation and senior fellow at Families USA, said during a briefing Tuesday.
By Samantha Liss • Sept. 23, 2020 -
CMS to expand ambulance prior authorization model nationwide
The model saved Medicare about $650 million in four years without changing care quality or access. However, the timeline for its rollout is still to be determined amid COVID-19 uncertainty.
By Rebecca Pifer • Sept. 23, 2020 -
Getty Images
Georgia practice to pay $1.5M after hacker accessed thousands of patient records
The group calling itself The Dark Overlord used a vendor's credentials and attempted to sell the data, including medical procedures and other personal information, online.
By Shannon Muchmore • Sept. 22, 2020 -
Radiation oncologists push back on new CMS payment model
The agency expects the value-based payment structure set to begin Jan. 1 will save Medicare $230 million over five years, but a trade group of providers is calling for a delay due to the COVID-19 pandemic.
By Susan Kelly • Sept. 21, 2020 -
Hospitals charge privately insured patients 250% more than those on Medicare. The gap is growing.
A RAND study of charge data from more than 3,000 hospitals points the finger at growing provider consolidation as a key culprit, but the AHA slammed the report as "based on a cherry-picked and limited dataset."
By Ron Shinkman • Sept. 18, 2020 -
Trump admin unveils final mandatory kidney care payment model
Forced participation in the ESRD model, where CMS will identify providers in randomly selected regions to take part, drew industry ire when it was first proposed one year ago.
By Samantha Liss • Sept. 18, 2020 -
'We feel bullish': Payers look ahead to 2021
Top execs at the biggest commercial insurers outlined shifting strategic priorities and growth opportunities in light of the COVID-19 recession at Morgan Stanley's annual healthcare conference last week.
By Rebecca Pifer • Sept. 17, 2020 -
CMS innovation agency to launch risk-based model for dual eligibles
Along with the dual-eligible demonstration, CMMI head Brad Smith said Tuesday industry could expect some additional models to come out of the pipeline in the next few months.
By Rebecca Pifer • Sept. 16, 2020 -
Adobe Stock
OCR settles with 5 more providers on HIPAA right of access violations
Three of the providers failed to give the patient medical records access until after a second complaint to the HHS Office of Civil Rights was submitted and validated.
By Shannon Muchmore • Sept. 16, 2020 -
Uninsured rate rose to 9.2% in US last year, pre-COVID-19 recession
The high cost of U.S. healthcare continues to stress the country's economic outlook overall. About 7.7 million more Americans would be considered low-income if their medical bills were factored in, the U.S. Census Bureau said.
By Rebecca Pifer • Sept. 16, 2020 -
FTC urges Texas regulators to block merger under COPA
The agency was blistering in its comments, warning regulators the deal would result in serious competitive and consumer harm in the form of higher prices, lower quality and diminished access to care and innovation.
By Samantha Liss • Sept. 15, 2020 -
CMS to ax inpatient data in MA risk scoring by 2022
The proposed changes should be a net positive for Medicare Advantage players, resulting in a 0.25% rise in risk scores.
By Rebecca Pifer • Sept. 15, 2020 -
Naomi Eide/Healthcare Dive
OSHA fines 3 hospital systems for PPE violations
Bergen New Bridge Medical Center said Monday afternoon it had not received the OSHA report but will "respond accordingly" when it does. The other two hospitals have not responded to requests for comment.
By Ron Shinkman • UPDATED: Sept. 15, 2020 at 10:12 a.m. -
Getty Images
CMS kills controversial Medicaid fiscal accountability rule
The rule proposed last year would have increased federal oversight of how states fund their Medicaid programs and potentially resulted in funding cuts for the cash-strapped program. Providers strongly opposed it.
By Rebecca Pifer • Sept. 14, 2020 -
White House
Trump releases long-awaited drug pricing order, but its effects are likely far off
The White House disclosed details of an order to cut Medicare prices to international rates, but the proposed plan will be difficult to carry out and could take months to enact.
By Jonathan Gardner • Sept. 14, 2020 -
Courtesy of Fitbit
Fitbit receives FDA clearance for ECG app
The wearables giant has trailed rivals in product development and approval in the heart rhythm tracking arena. The nod brings it up to speed with Apple and Samsung.
By Rebecca Pifer • Sept. 14, 2020 -
OIG says $2.6B paid out under MA risk adjustment with scant encounter data
The watchdog's analysis also found health risk assessments were taking place at a patient's home, and were often conducted by providers contracted by the health plan instead of their actual physician.
By Ron Shinkman • Sept. 11, 2020 -
Opinion
Hospice respite flexibility is recipe for more patient protection
The CEO of the National Hospice and Palliative Care Organization writes in support of a bill that would allow respite care to be provided outside of inpatient settings and hospice patients to receive up to 15 days of respite care.
By Edo Banach • Sept. 09, 2020 -
Hospitals urge HHS to step in on 340B fight with drug manufacturers
On Friday, more than 1,100 hospitals sent another letter to HHS urging it to take action against drug manufacturers limiting drug distribution to 340B facilities.
By Shannon Muchmore • UPDATED: Sept. 11, 2020 at 10:01 a.m.
