CVS-Aetna merger cleared by California's insurance regulator

The state's reluctant nod came after the entity promised not to increase premiums as a result of acquisition costs. The deal now awaits regulatory approval from four more states and is expected to close by Thanksgiving.

By Rebecca Pifer Parduhn • Nov. 15, 2018

In rebound, ACA marketplace to offer more payer options in 2019

Despite concerns of more problems in 2018, ACA payers have actually found their footing — and are even enjoying profits now. Centene, Cigna, Oscar Health, Anthem and Wellmark are moving back into the market or expanding to more counties in 2019.

By Les Masterson • Nov. 15, 2018

CMS approves Michigan Medicaid drug value-based payment plan

Administrator Seema Verma also previewed forthcoming agency action on protected classes of drugs in Medicare Part D, hinting that CMS plans to further open the space to private negotiation.

By David Lim • Nov. 14, 2018

Managed Medicaid plans treat chronic conditions on par with other commercial coverage, AHIP report finds

The payer group looked at data involving patients with asthma, diabetes and mood disorders to see how clinical care compared between Medicaid, commercial insurance and those who are uninsured.

By Les Masterson • Nov. 14, 2018

'Stay tuned,' says Azar: CMMI to take a closer look at social determinants of health

It's unclear how the administration will balance tackling social determinants of health and keeping regulatory burden low.

By Rebecca Pifer Parduhn • Nov. 14, 2018

Nearly 50K would lose Medicaid under Arkansas work rules: study

Gresham v. Azar seeks to halt the work requirement experiment on grounds it runs counter to Medicaid law and risks the health of Arkansas' most vulnerable citizens.

By Meg Bryant • Nov. 14, 2018

It's final: Amazon pegs NYC, Virginia for HQ2 (with nod to Nashville)

The Tennessee capital was a surprise winner, landing 5,000 jobs as part of an "operations center of excellence." 

By Samantha Liss • Nov. 13, 2018

CMS finds Strong Start birth centers save money, improve outcomes

Rates of preteen birth, unhealthy birthweight and cesarean section were all lower among birth center participants — as were costs.

By Les Masterson • Nov. 12, 2018

Post midterm win, Medicaid backers eye expansion in more red states

Victories in three states are inspiring backers in Missouri, Mississippi and Oklahoma who found themselves boxed out by Republican lawmakers unwilling to extend health coverage to more low-socioeconomic status residents. 

By Samantha Liss • Nov. 12, 2018

HHS teases mandatory bundled models in about-face

If such methods are needed to deliver change, HHS Secretary Alex Azar said Thursday, "mandatory models are going to see a comeback."

By Rebecca Pifer Parduhn • Nov. 9, 2018

Without more stewardship, superbugs could kill thousands more Americans annually by 2050

But spending just $2 per person a year on measures like handwashing and more sensible prescribing could prevent three out of four of those deaths, according to the Organisation for Economic Co-operation and Development.

By Meg Bryant • Nov. 9, 2018

Medicaid managed care proposal would tweak network adequacy standards

The proposed rule from CMS aims to create flexibility by removing "outdated" requirements that govern how plans communicate with beneficiaries and barriers to transitioning new services and populations into managed care.

By Tony Abraham • Nov. 9, 2018

Price, usage drive variations between regions' healthcare costs, report finds

Of six regions studied, Maryland had the lowest costs at 20% below the benchmark. On the other end, Colorado was 19% above the standard and Minnesota was 11% higher.

By Les Masterson • Nov. 9, 2018

Signups lag in first days of ACA open enrollment

It's still early in the process, but enrollment will need to pick up significantly over the next month to approach last year's numbers, according to CMS data.

By Les Masterson • Nov. 8, 2018

ACA, hospitals win as health focus helps Dems flip House

Democrats will be able to swat down any attempts at repealing the Affordable Care Act, but it's unlikely Congress will stitch together repair efforts for the ACA, either, analysts warn.

By Samantha Liss • Nov. 7, 2018

Red states say 'yes' to Medicaid

Three GOP-heavy states expanded Medicaid on Tuesday, and Democratic governor pickups could further the trend. Elsewhere on midterm ballots, nurse-to-patient staffing ratios lost and California hospitals scored a win.

By Rebecca Pifer Parduhn • Nov. 7, 2018

Earnings reveal pharma's mixed feelings on Trump drug pricing proposal

A plan that would shake up how CMS pays for Medicare Part B drugs could leave the bottom lines of major players like Roche, Amgen and Bristol-Myers exposed, according to analysts.​

By Jacob Bell • Nov. 7, 2018

5 election takeaways for pharma

Democrats took back the House on Tuesday, raising the prospect of more scrutiny on drug pricing. Experts, however, don't expect a major deal with President Trump.

By Ned Pagliarulo • Nov. 7, 2018

North Carolina proposes setting hospital payments for state employees on Medicare rates

Hospitals elsewhere are likely to watch the plan closely, worried it could set a precedent. The move comes as providers are pushing back against CMS price cut proposals and on the defensive against complaints about high costs.

By Meg Bryant • Nov. 6, 2018

Land O'Lakes calls itself first to offer new association health plans

The Trump administration has encouraged AHPs to spur cheaper health insurance options, but critics call out flexibility for plans to offer skimpier protections.

By Les Masterson • Nov. 5, 2018

After provider uproar, CMS steps back from major E/M revamp

The agency's final Physician Fee Schedule rule for 2019 cuts E/M documentation requirements, pushes controversial E/M coding changes to 2021, adds telehealth payments and lowers the amount CMS pays for new drugs.

By Tony Abraham • Nov. 2, 2018

Hospitals slammed with $380M in CMS cuts, industry cries foul

CMS says the changes will create a level playing field by cutting reimbursement for visits to hospital-owned outpatient facilities. AHA said it will bring legal action.

By Samantha Liss • Updated Nov. 2, 2018

Medicare Advantage audits could save $4.5 billion over a decade, CMS says

America’s Health Insurance Plans questions the audits and how they could affect health insurers and beneficiaries. 

By Les Masterson • Nov. 2, 2018

9 state healthcare battles to watch Tuesday

It's not just Congress up for grabs in today's midterm elections. From Medicaid expansion to dialysis treatments to nurse staffing ratios, here's a snapshot of key votes, the odds and what they could mean for the industry.

By David Lim , Tony Abraham , Rebecca Pifer Parduhn , Samantha Liss • Nov. 2, 2018

HHS proposes start date for 340B ceiling price after hospital pressure

After delaying the start date five times, the department has proposed enforcing ceilings for the drug pricing program beginning Jan. 1. Hospital groups that sued the agency applauded the move.

By Tony Abraham • Updated Nov. 1, 2018