Government
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Frustration over surprise billing implementation builds in House hearing
Bipartisan lawmakers joined together to voice concerns about the implementation of the No Surprises Act, which critics say has created barriers to care.
By Susanna Vogel • Sept. 20, 2023 -
Home health advocates raise alarm over payment cuts, access to care
A new payment model and reimbursement cuts are straining home health agencies, but more data may be needed to fully evaluate the model, advocates and researchers said during a Senate finance committee hearing.
By Emily Olsen • Sept. 20, 2023 -
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9dreamstudio via Getty ImagesTrendlineSurprise Billing
Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.
By Healthcare Dive staff -
PBMs, PhRMA trade blame over drug costs in House hearing
Pharmacy benefit manager lobby PCMA and drugmaker lobby PhRMA pointed fingers over problems in the prescription supply chain during the House committee's second PBM hearing on Tuesday.
By Rebecca Pifer • Sept. 19, 2023 -
Over 80% of nursing homes currently fall short of proposed CMS staffing thresholds
In over half of states, less than a quarter of nursing facilities would meet staffing requirements under a proposed federal rule, according to a new KFF analysis.
By Susanna Vogel • Sept. 19, 2023 -
National Institute of Allergy and Infectious Diseases. (2017). "Human Respiratory Syncytial Virus" [Micrograph]. Retrieved from Flickr.
New RSV vaccines can be powerful tools, but rollout poses test
Public health officials and drugmakers are trying to raise awareness of RSV among at-risk older adults — and convince them to get an additional respiratory shot alongside those for COVID-19 and flu.
By Delilah Alvarado • Sept. 18, 2023 -
Tennessee BCBS sued by former employees over COVID vaccine mandate
The new lawsuit alleges the nonprofit health plan violated employees' religious rights by not granting them an exemption to its inoculation requirement.
By Rebecca Pifer • Sept. 18, 2023 -
CMMI teases new behavioral, maternal health models launching this year
The timeline of the two upcoming models could be pushed back if Congress doesn’t come to a funding agreement and the government shuts down, CMMI head Liz Fowler said.
By Rebecca Pifer • Sept. 15, 2023 -
PBM reforms in Congress would have modest effect at best and backfire at worst, Brookings says
Congress is inching closer to pharmacy benefit manager reform with new legislation released last week. But even eliminating all PBM profits would barely move the needle on U.S. drug spending, according to a new report.
By Rebecca Pifer • Sept. 13, 2023 -
Lawmakers introduce bipartisan legislation addressing workplace violence in hospitals — again
Despite widespread support from healthcare workers and hospital associations, federal regulations protecting hospital workers have previously failed to advance in Congress.
By Susanna Vogel • Sept. 13, 2023 -
CDC endorses new COVID boosters as focus turns to rollout
Agency advisers voted 13-1 to recommend the updated shots for everyone over the age of 6 months, greenlighting the vaccines’ rollout one day after the FDA’s approval.
By Delilah Alvarado • Sept. 13, 2023 -
Photo by Yan Krukov from Pexels
Low-income seniors more likely to report fraudulent marketing from private Medicare plans
The Commonwealth Fund survey comes after regulators finalized a rule this spring aiming to cut back on deceptive and misleading advertising for Medicare Advantage plans after beneficiary complaints rose.
By Emily Olsen • Sept. 12, 2023 -
L.A. Care to pay $1.3M to settle potential HIPAA breach violations
The settlement comes after state regulators levied a $55 million fine against the health plan last year for alleged operational deficiencies, including failure to address a backlog of over 9,000 prior authorization requests.
By Sydney Halleman • Sept. 12, 2023 -
Indiana hospital settles suit over 2021 data breach, will pay $250K
The state alleged the hospital knew about security issues before the attack and failed to directly notify patients for more than 200 days.
By Emily Olsen • Sept. 11, 2023 -
Kaiser Permanente to pay $49M after investigators found syringes, medical records in trash
The settlement concludes an eight-year investigation, during which investigators reviewed dumpster contents and found “hundreds of items” of hazardous waste and paper records containing patient health information.
By Susanna Vogel • Sept. 11, 2023 -
MA enrollment in rural areas nearly quadrupled since 2010, KFF finds
More rural seniors are turning to Medicare Advantage, but the plans can offer limited provider networks. That could prove an additional challenge for rural beneficiaries who already have to travel further distances for care.
By Emily Olsen • Sept. 8, 2023 -
Medical credit cards ‘exploit loopholes’ in healthcare debt protection, report finds
The credit cards, which can promise patients deceptive no- or low-interest rates, are increasingly being offered in hospitals and physician offices.
By Sydney Halleman • Sept. 8, 2023 -
Unionized nursing homes more likely to report workplace injuries and accidents
Only 40% of nursing homes nationwide complied with reporting requirements between 2016 and 2021, despite nursing homes being among the most dangerous workplaces in America, according to the Health Affairs study.
By Susanna Vogel • Sept. 7, 2023 -
Astellas withdraws lawsuit challenging Medicare drug price program
Contrary to the drugmaker’s expectations, its top-selling cancer medicine Xtandi wasn’t picked as one of the first 10 drugs to face price negotiations.
By Ned Pagliarulo • Sept. 7, 2023 -
‘Revolving door’ between HHS and industry could influence regulation, study says
Thirty-two percent of people appointed to positions at the HHS between 2004 and 2020 exited to the private sector, raising concerns about objectivity, according to new research.
By Emily Olsen • Sept. 7, 2023 -
FDA proposes 3 guidances to improve 510(k) clearance process
The agency has made recommendations for selecting predicate devices, using clinical data and conducting performance testing for implants.
By Nick Paul Taylor • Sept. 7, 2023 -
MA plans were overpaid $9.3B annually from 2017 to 2020, study finds
Favorable selection of healthier beneficiaries led to overpayments in counties with high Medicare Advantage penetration, but benchmark changes could mitigate the impact.
By Emily Olsen • Sept. 6, 2023 -
CMS creates all-payer funding opportunity for states
Regulators' latest effort to nudge the U.S. away from fee-for-service takes a page from how Maryland pays its hospitals.
By Rebecca Pifer • Sept. 6, 2023 -
Humana sues HHS over Medicare Advantage audits
The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.
By Rebecca Pifer • Sept. 5, 2023 -
Biden administration proposes landmark nursing home staffing minimums
The controversial proposal would require nursing homes to have a registered nurse on site 24/7 and have three hours of care per resident per day.
By Susanna Vogel • Sept. 1, 2023 -
ONC taps Sequoia Project as TEFCA overseer, again
The nonprofit will receive $2 million in funding from the government in the first year of its new five-year contract for managing the interoperability network.
By Rebecca Pifer • Aug. 31, 2023