Policy & Regulation

FTC commissioner pledges hard line on hospital mergers

Lobbyists and legislators also spoke at a Council for Affordable Health Coverage forum, noting a surprise billing ban is still on the table for Congress despite disagreements over the policy to achieve it.
By Shannon Muchmore • Jan. 17, 2020
MedPAC finds 340B effect on pricing 'modest,' going against pharma critique

The commission's report provides some new ammunition in the ongoing battle between pharmaceutical companies and nonprofit disproportionate share hospitals over the future of the 340B drug discount program.
By Rebecca Pifer • Jan. 17, 2020
After 2 years of turmoil, state exchange premiums stable for now, report finds

More robust reinsurance programs and commercial offerings from insurers such as Bright Health and upstart Oscar are playing a role, according to the Robert Wood Johnson Foundation and Urban Institute.
By Ron Shinkman • Jan. 17, 2020
Racial and ethnic disparities in care narrowed under ACA, Commonwealth Fund says

Previous progress in lowering the uninsured rate stalled after 2016.
By Linda Wilson • Jan. 16, 2020
Trump admin releases 5-year health IT roadmap as industry waits for interoperability update

The report will not impact long-awaited rules promoting interoperability in healthcare, which HHS plans to release early this year.
By Rebecca Pifer • Jan. 15, 2020
AHA files another challenge to CMS site neutral payment policy

The same court ruled in favor of hospitals in September, but later determined it could not keep CMS from attempting the policy again for 2020.
By Shannon Muchmore • Jan. 14, 2020
Dignity Health loses appeal of Medicaid out-of-network billing case

The hospital operator said it may try to take the case against L.A. Care, the largest public Medicaid managed care plan in the country, to the California Supreme Court.
By Ron Shinkman • Jan. 13, 2020
Supreme Court to take on PBM rate regulation

A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.
By Samantha Liss • Jan. 13, 2020
A biotech startup launches with unusual goal: invent new drugs, and sell them for less

Founded by venture capitalist Alexis Borisy, EQRx will launch with $200 million in funding to prove out a vision as daunting as it is ambitious.
By Ned Pagliarulo • Jan. 13, 2020
The government recovered $3B in fraud last year. Nearly 90% was from healthcare

It marks the 10th consecutive year the DOJ has recouped more than $2 billion from False Claims Act settlements and judgments for HHS.
By Rebecca Pifer • Jan. 10, 2020
Kansas to become 37th state to expand Medicaid under ACA

Kansas joins a flurry of Republican-leaning states that have either expanded the program through their legislatures or via voter initiative, including Utah, Idaho and Nebraska.
By Ron Shinkman • Jan. 10, 2020
US cancer death rate drops by most on record

Reductions in smoking and earlier cancer detection have driven death rates lower, but newer treatments could be playing a larger role, too.
By Ned Pagliarulo • Jan. 09, 2020
Kaiser, major union launching nonprofit to boost California workforce

The $130 million organization, called Futuro Health, has a goal of graduating 10,000 new licensed and credentialed workers for the state in the next four years.
By Shannon Muchmore • Jan. 09, 2020
Social risk factors may influence CMS star ratings, study suggests

Providers have disputed the methodology CMS uses to compile its star ratings for years, saying the approach is overly simplistic and the presentation of data to consumers is difficult to interpret.
By Linda Wilson • Jan. 09, 2020
Individual market appears stable despite lack of mandate penalty

Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.
By Shannon Muchmore • Jan. 08, 2020
CMS proposes using more encounter data for MA risk adjustment

The mix of encounter data used to calculate payments would go up to 75% next year under the proposed regulation. Payers have railed against previous increases, saying the information is inaccurate and unreliable.
By Shannon Muchmore • Jan. 07, 2020
Ex-Anthem exec Brad Smith appointed head of CMS innovation center

Smith, previously co-founder and CEO of palliative care company Aspire Health, replaces outgoing CMMI head Adam Boehler.
By Rebecca Pifer • Jan. 07, 2020
Beyond the ACA: Healthcare legal fights to watch in 2020

Payers and providers are contesting a price transparency push. The Trump administration is also being challenged over risk corridor payments and the expansion of association health plans.
By Shannon Muchmore , Samantha Liss • Jan. 06, 2020
Providers embrace loosening Stark Law regulations, suggest feds could go further

The Trump administration's proposed relaxation of regulations around the law has nearly unanimous support in both the hospital and physician community, most of whom say they are chafing against the requirements.
By Ron Shinkman • Jan. 06, 2020
Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020

List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
By Andrew Dunn • Jan. 02, 2020
Despite provider claims, hospital M&A not associated with improved care, NEJM finds

The findings refute a common provider justification for rampant M&A, but the American Hospital Association pushed back on researchers' reliance on patient surveys.
By Rebecca Pifer • Jan. 02, 2020
Tenet deal to sell Memphis properties raises hackles of other area providers

One health system said it is "reasonably certain the FTC will be reviewing this proposed transaction given the potential negative impact it could have on the consumers in Memphis."
By Ron Shinkman • Dec. 30, 2020
Utah Medicaid expansion, with controversial work rules, gets nod

CMS did not approve other elements of the state's request, including charging premiums to adults with incomes above 100% of the federal poverty level and locking people out for violations.
By Linda Wilson • Dec. 24, 2019
ACA 2020 enrollment stable but dips slightly

CMS attributed the decline to a few factors, including a strong economy that may have moved more people into job-based coverage and states expanding Medicaid eligibility.
By Ron Shinkman • Dec. 23, 2019
Sutter to pay $575M, change contracting practices in antitrust settlement

Pending approval, the deal bars the dominant Northern California system from using all-or-nothing contracts and stops certain bundling practices.
By Shannon Muchmore • Dec. 20, 2019