Policy & Regulation: Page 2
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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 -
UnitedHealth, Anthem, Cigna roped into House surprise billing probe
The Energy and Commerce Committee wants data on in-network and out-of-network pricing and the frequency of surprise billing. Private-equity backed Envision Healthcare and Team Health also received letters.
By Samantha Liss • Dec. 20, 2019 -
MA value-based plan enrollment tripling for 2020
CMS also moved to fold hospice care into Medicare Advantage, a cost-cutting step industry has expected for a while.
By Rebecca Pifer • Dec. 20, 2019 -
ONC data reveal safety issues in some EHRs
The types of potential patient safety issues included laboratory test results not importing into the EHR properly and decimal points being removed from medication dosage entries, according to new JAMA research.
By Linda Wilson • Dec. 19, 2019 -
ACA's individual mandate ruled unconstitutional but key question kicked back to lower court
The long-awaited ruling is a win for Republican-led states attempting to kill the Obama-era law. States defending the ACA said they will challenge the decision.
By Samantha Liss • UPDATED: Dec. 18, 2019 at 6:39 p.m. -
Trump administration lays out plans to import drugs from abroad
But it's not clear how effective importation would be at achieving the administration's goal of reducing drug prices. High-cost drugs like biologics, for example, are excluded from one of the two proposals.
By Ned Pagliarulo • Dec. 18, 2019 -
CMS wants to overhaul how organs are procured in the US
The agency estimates if all procurement groups met both the new donation and transplantation rate measures, the number of yearly transplants would shoot up more than 15% by 2026.
By Rebecca Pifer • Dec. 17, 2019 -
Florida medical group to pay $85K for not providing medical records to patient
It's the second enforcement action against a provider in such a case by the Office for Civil Rights at HHS.
By Ron Shinkman • Dec. 16, 2019 -
ACA taxes repealed in year-end spending legislation, with no surprise billing ban
Lawmakers insist a ban on surprise billing will be a top legislative priority for next year, but the spending package does not touch on the issue.
By David Lim • UPDATED: Dec. 23, 2019 at 10:23 a.m. -
Culling surprise billing would save $40B annually, Health Affairs study finds
The research also found that out-of-network billing was most common at for-profit hospitals and in areas with highly concentrated provider and payer markets.
By Shannon Muchmore • Dec. 16, 2019 -
Boston Scientific gets 1st US disposable duodenoscope clearance
Reusable duodenoscopes, used during procedures to diagnose or treat bile duct, liver, gall bladder and pancreas issues, have been linked to persistent contamination issues tied to multiple patient deaths.
By David Lim • Dec. 16, 2019 -
HHS watchdog accuses MA plans of inflating payments by nearly $7B annually
The apparent overpayments are tied to payers tacking on new diagnosis codes as part of a review of existing medical charts, a practice CMS is encouraged to watch more closely.
By Ron Shinkman • Dec. 13, 2019 -
Hospital group cheers CMS move to pay back outpatient payment cuts
Despite the win for hospitals, the showdown is likely to ramp up again as the federal regulator said it will keep the controversial site-neutral policy for 2020.
By Samantha Liss • Dec. 13, 2019 -
Amid legal roadblocks, CMS clears South Carolina Medicaid work mandates
The administration has approved work requirements in ten states so far, though three (New Hampshire, Kentucky and Arkansas) have seen their programs struck down by a federal judge.
By Rebecca Pifer • Dec. 12, 2019 -
Few Medicare Advantage plans add new benefits for serious illness
Starting this year, CMS gave the plans flexibility to offer more benefits for nonmedical services like home-based palliative care, adult daycare services, bathroom safety devices and modifications.
By Linda Wilson • Dec. 11, 2019 -
Surprise billing ban draft: Middle ground leaves few pleased
The bill backed by a bipartisan group of Senate and House leadership would require insurers pay at least the median in-network negotiated rate for the area market for out-of-network services and has an arbitration backstop.
By Shannon Muchmore • Dec. 10, 2019 -
Supreme Court to hear $12B ACA risk corridors case this week
The justices will consider the case Tuesday. Observers say the money will not be the ultimate thrust of the court's decision — it's whether the business sector will have trust in the federal government in current and future partnerships.
By Ron Shinkman • Dec. 09, 2019 -
Competing House surprise billing plan muddies path of White House-backed legislation
The House Ways and Means Committee unveiled its own surprise billing legislation Wednesday that relies on arbitration.
By Shannon Muchmore • UPDATED: Dec. 12, 2019 at 9:21 a.m. -
Biotech's Alzheimer's pitch polarizes scientists
Two large clinical trials testing Biogen's drug aducanumab in patients with less advanced disease looked negative after early analyses, leading the company to stop them before they finished.
By Jacob Bell • Dec. 09, 2019 -
Dive Awards
The Healthcare Dive Awards for 2019
From the Affordable Care Act lawsuit to CVS Health CEO Larry Merlo, these are the companies, executives and movements that shaped U.S. healthcare this year.
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Roche MRSA test wins FDA OK
The agency said the novel diagnostic technology can deliver results in as little as five hours, compared to the one- to two-day wait time with conventional methods.
By Nick Paul Taylor • Dec. 06, 2019 -
US healthcare spending growth rebounded last year, influenced by insurance tax
Hospital and physician and clinical services spending fell, but prices were up. CMS Administrator Seema Verma blamed provider consolidation and the "creation of monopolies."
By Shannon Muchmore • Dec. 05, 2019 -
More state laws back telehealth, but many stop short of mandates
While regulations have inhibited growth in the past, many states are warming up to the adoption of virtual services. That's a "sea change compared to a decade ago," Foley & Lardner lawyers said.
By Linda Wilson • Dec. 05, 2019 -
Medicare Advantage members rarely review or switch plans
A Kaiser Family Foundation analysis found that more than one in three Medicare beneficiaries reported difficulty comparing plan options and nearly half of those on Medicare said they rarely or never review their choices.
By Shannon Muchmore • Dec. 04, 2019
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