Policy & Regulation: Page 2
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Teva, Endo among generics paying $70M in California pay-for-delay settlement
The state accused Teva, Endo and Japan-based Teikoku of anticompetitive practices on two drugs, which it said drove healthcare costs higher.
By Jacob Bell • July 30, 2019 -
CMS pilot to give docs direct access to Medicare claims data
The agency hopes to eventually roll out the initiative to all Medicare fee-for-service providers, giving doctors Medicare claims data for their patients, including prescribed medications, procedures, diagnoses and other providers.
By David Lim • July 30, 2019 -
Judge nixes New Hampshire's Medicaid work requirement
The ruling is the third time the judge has shot down such demonstration projects, having vacated similar plans in Arkansas and Kentucky on identical grounds.
By Dana Elfin • July 30, 2019 -
CMS proposes forcing hospitals to reveal negotiated rates
Insurer and hospital groups swiftly pushed back against a mandate to publish payer-specific rates for at least 300 services that patients can plan in advance. A legal challenge is likely.
By Samantha Liss • July 30, 2019 -
SponsoredCOB innovation: Identifying Medicaid 3rd party liability prior to the point of care
Improperly declaring Medicaid as the primary payer when other coverage exists is a seemingly small error that has widespread implications for the healthcare ecosystem.
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Mylan's tumble ends with Pfizer rescue
A deal marrying Mylan with Pfizer's off-patent drugs unit will help prop up the struggling generics maker now, but long-term growth remains in question.
By Jonathan Gardner • July 29, 2019 -
CMS will no longer approve full federal funding for partial Medicaid expansion
The policy pivot dashes the hopes of a handful of Republican states looking to receive more federal money for covering fewer people than states with full Medicaid expansion under the Affordable Care Act.
By Rebecca Pifer • July 29, 2019 -
Hospital groups propose overhaul to patient satisfaction survey
The questionnaire "has a great track record, but it has not been closely looked at in more than a decade," said Federation of American Hospitals President Chip Kahn, adding hospital care has evolved in that time.
By Shannon Muchmore • July 25, 2019 -
OIG suggests closer look at impact of rule pushing risk on Medicare ACOs
In another recommendation on the Medicare Shared Savings Program, the watchdog suggested CMS adopt outcomes-based performance measures — rather than process measures — and standardize measures across programs.
By Linda Wilson • July 25, 2019 -
As HHS muses more MA flexibility, payers see roadblocks to nonmedical benefits
Implementation challenges, uncertain return on investment and a lack of clarity on what supplemental benefits are allowed are making some payers wary of offering nonmedical services in Medicare Advantage.
By Rebecca Pifer • July 24, 2019 -
Senate committee targets Medicare drug price increases with bipartisan bill
Legislation proposed Tuesday would also reimburse physicians less for administering expensive intravenous drugs to beneficiaries.
By Jonathan Gardner • July 23, 2019 -
CMS' Verma blasts 'Medicare for All,' public option in rhetoric ramp up
The remarks were unusually strong for the CMS leader. Though she has often beat the party drum on plans conservatives call a dangerous step toward socialism, the breadth and specifics of her critique expanded.
By Rebecca Pifer • July 23, 2019 -
ACA, other coverage expansions not linked with rising hospital use, study shows
Researchers looked at hospital use after introduction of Medicare and Medicaid and after the ACA and concluded universal coverage "is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained."
By Shannon Muchmore • July 23, 2019 -
ACOs with 2-sided risk can cut cost, improve quality, study finds
A Blue Cross Blue Shield of Massachusetts population health program cut per-enrollee spending and resulted in more chronic disease management, according to research in the New England Journal of Medicine.
By Ron Shinkman • July 22, 2019 -
As unprecedented CVS-Aetna review wraps, few clues from judge
Although CVS is now operating and reporting results to Wall Street with Aetna included, the decision could have huge repercussions, especially if the judge orders CVS to go beyond Aetna's divestiture of its Part D business.
By Dana Elfin • July 21, 2019 -
Judge upholds short-term plan expansion in Trump win against ACA
The plaintiffs, including the Association for Community Affiliated Plans, the National Alliance on Mental Illness and AIDS United, appealed the decision upholding the controversial policy Monday.
By Rebecca Pifer • UPDATED: July 29, 2019 at 2:22 p.m. -
State telehealth use climbing, but barriers to broader adoption remain
North Carolina, Ohio and Montana have distance restrictions on virtual care services, a sign of varying policies among states, according to a new report from a large telehealth trade group.
By Dana Elfin • July 19, 2019 -
High-deductible plans can offer more access to preventive treatment under new rule
Under the guidance, potentially life-saving healthcare services and products used to treat common chronic diseases can be covered as preventive services in high-deductible health plans before enrollees reach their annual deductible.
By Linda Wilson • July 18, 2019 -
Surprise billing legislation saves $7.6B, trims premiums, budget watchdog says
The sweeping Senate bill, which also tackles drug costs and bars certain contracts between payers and providers, was passed out of committee with bipartisan support last week.
By Samantha Liss • July 17, 2019 -
CVS launches home hemodialysis device clinical trial
The drugstore giant, which now includes insurance heavyweight Aetna, said it can help reduce the $35 billion in Medicare costs associated with the treatment of end-stage renal disease.
By Shannon Muchmore • July 17, 2019 -
Surprise billing fight escalates as providers win arbitration add to House bill
Insurers and health policy experts are pushing back against the controversial change to the bill, which will let providers or payers appeal to an independent arbiter in cases where the median in-network rate tops $1,250.
By Rebecca Pifer • UPDATED: July 17, 2019 at 4:11 p.m. -
Intermountain starts new company to spur shift toward value
The effort will be led by Rajesh Shrestha, Intermountain vice president and chief operating officer of community based care.
By Shannon Muchmore • July 16, 2019 -
CMS proposes Medicare cover acupuncture for patients in approved studies
Medicare doesn't usually cover alternative medical procedures, but the government is looking for ways to reduce the nation's dependence on highly addictive opioids for chronic pain.
By Rebecca Pifer • July 16, 2019 -
OpinionAn important first step toward eliminating the transplant waitlist
Global Liver Institute president and CEO Donna Cryer discusses how the U.S. liver transplant system has failed patients — and how President Donald Trump's ambitious new renal care plan could help.
By Donna Cryer • July 15, 2019 -
Participation in APMs, MIPS climbed significantly in 2018
Many physicians have rejected the programs, saying they contain too many rules and rely too much on expensive investments in EHRs.
By Ron Shinkman • July 15, 2019
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