MA premiums increase slightly for 2024

CVS, UnitedHealth and Humana expanded their MA footprints 13%, 4% and 2% respectively for next year, according to an analyst analysis of the CMS data.

By Rebecca Pifer • Sept. 27, 2023

Elevance, BCBSLA pause $2.5B merger amid regulatory scrutiny

The health insurers originally expected their merger to close before the end of 2023, but have hit snags receiving the regulatory green light in Louisiana.

By Rebecca Pifer • Sept. 26, 2023

FDA staff hold ‘major concerns’ with Brainstorm ALS therapy, documents show

Agency scientists flagged numerous issues with Brainstorm’s stem cell treatment ahead of a high-profile Wednesday meeting of expert FDA advisers.

By Ned Pagliarulo • Sept. 25, 2023

CMS to get ‘tougher’ on Medicare Advantage, official promises

Deputy Administrator Jon Blum signaled regulators could increasingly crack down on bad actors in the MA program, which now covers more than half of Medicare seniors.

By Rebecca Pifer • Sept. 22, 2023

Federal agencies propose increase to No Surprises Act administrative fees

On Thursday, the HHS and other departments proposed a rule that would raise the independent dispute resolution process fees from $50 to $150. Last month, a federal court vacated a rate of $350.

By Susanna Vogel • Sept. 22, 2023

CMS requires 30 states to pause Medicaid disenrollments after systems error

Nearly 500,000 people will regain Medicaid or Children’s Health Insurance Program coverage after being improperly removed from the rolls during redeterminations, according to the HHS.

By Emily Olsen • Sept. 22, 2023

Biden administration seeks to erase medical debt from credit reports

In kicking off a medical debt rulemaking process, the Consumer Financial Protection Bureau aims to tackle what is a “serious pain point” for many families, Director Rohit Chopra said Thursday.

By Caitlin Mullen • Sept. 22, 2023

The one code Congress must support: G2211

Presidents of the American Academy of Family Physicians and the American College of Physicians argue for reforms in the national physician payment system.

By Tochi Iroku-Malize and Omar T. Atiq • Sept. 22, 2023

FTC sues US Anesthesia Partners, Welsh Carson over alleged price collusion in Texas

The PE firm and its anesthesia network rolled up multiple physician practices over the past decade, creating a dominant provider and charging Texans “tens of millions of dollars” more each year for anesthesia services, regulators allege.

By Rebecca Pifer • Sept. 21, 2023

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

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

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

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