Government: Page 34
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CMS tweaks ACO REACH to stabilize model
Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.
By Rebecca Pifer • Aug. 15, 2023 -
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Deep DiveWill the Biden administration’s short-term plan rule increase the uninsured rate?
Free-market advocates argue proposed restrictions on short-term plans will leave consumers without coverage. Health policy researchers aren’t so sure.
By Rebecca Pifer • Aug. 14, 2023 -
DOJ hits UnitedHealth, Amedisys with second request over $3.3B deal
The request for more information pushes back the timeline of the merger as regulators take a more active stance in healthcare M&A oversight.
By Rebecca Pifer • Aug. 11, 2023 -
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HHS pledges more than $100M to grow nursing workforce
The investment aims to reduce bottlenecks in nurse training that stakeholders say hamper recruitment efforts.
By Susanna Vogel • Aug. 10, 2023 -
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MA bonuses reach record high, with UnitedHealthcare, Humana biggest winners
Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.
By Rebecca Pifer • Aug. 10, 2023 -
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Senators crack down on nonprofit hospitals’ charity care, tax-exempt status
The letter, sent by a bipartisan group of senators to tax commissioners, comes as the federal government increases scrutiny into nonprofit hospitals’ charity care spending.
By Sydney Halleman • Aug. 9, 2023 -
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Texas judge rules in favor of doctors in latest suit over surprise billing process
The decision is expected to increase the number of claims providers file in the independent dispute resolution process, especially for smaller amounts, according to a health lawyer.
By Rebecca Pifer • Aug. 7, 2023 -
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DEA open to considering special registration for telehealth controlled substance prescriptions
The announcement comes after the agency received more than 38,000 public comments in response to a proposal that would restrict telehealth prescriptions, with “a significant majority” expressing concern.
By Emily Olsen • Aug. 7, 2023 -
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FDA approves Sage, Biogen drug for postpartum depression, but rejects wider use
The approval of Zurzuvae marks the first time the FDA has approved a pill for postpartum depression.
By Jacob Bell • Aug. 5, 2023 -
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Health insurers ignore surprise billing decisions, providers allege
Payers didn’t reimburse doctors in more than half of arbitration award cases, according to a survey from clinician group Americans for Fair Health Care.
By Rebecca Pifer • Aug. 4, 2023 -
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Kentucky sues major PBMs over rising insulin prices
A string of states and cities have filed recent suits against PBMs and drug manufacturers alleging they work in tandem to raise the cost of insulin.
By Sydney Halleman • Aug. 4, 2023 -
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UnitedHealth unit sued by Labor Department over systematic claims denials
The government is alleging plan administrator UMR improperly denied thousands of ER and drug screening claims submitted between 2015 and 2018.
By Susanna Vogel • Aug. 2, 2023 -
CMS finalizes 3.1% inpatient payment bump for hospitals
Hospitals decried the rate adjustment, which is higher than the 2.8% proposed earlier this year, as out of touch with their financial reality.
By Rebecca Pifer • Aug. 2, 2023 -
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Hospital, payer lobbies urge CMS to reconsider ‘conflicting’ prior authorization standards
The groups, normally at odds, have found a source of agreement in proposed rules meant to standardize data exchange processes.
By Brian T. Horowitz • July 31, 2023 -
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CMS releases April Medicaid unwinding data. Total disenrollments top 3.8M
The highly-anticipated data pegging the nation’s procedural disenrollment rate at 80% is higher than more recent estimates.
By Rebecca Pifer • July 28, 2023 -
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CMS says data of 612K Medicare beneficiaries affected in MoveIt breach
A data breach earlier this year has affected tens of millions of individuals to date, and also compromised the sensitive personal and medical information of Medicare seniors.
By Rebecca Pifer • July 28, 2023 -
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FTC reaches proposed settlement with Surescripts in antitrust case
The lawsuit alleged the health IT vendor monopolized e-prescription drug markets for routing and eligibility through exclusivity agreements, threats and other exclusionary conduct.
By Emily Olsen • July 28, 2023 -
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Nevada to shut down Friday Health Plans
State regulators will liquidate the failing insurtech, leaving about 3,000 enrollees to look for new coverage.
By Emily Olsen • July 27, 2023 -
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Cleveland sues major PBMs, drug manufacturers over rising insulin prices
The suit argues that PBMs, including CVS Caremark, Express Scripts and OptumRx, use their market power to drive up the cost of insulin for Cleveland residents — approximately 17% of whom are diabetic.
By Sydney Halleman • July 26, 2023 -
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Biden administration cracks down on payers over mental health coverage
A new proposed rule from the HHS and Treasury and Labor departments would require health insurers to analyze patient outcomes to ensure their benefits are administered equally.
By Rebecca Pifer • July 25, 2023 -
Carol Highsmith. (2005). "The Apex Building" [Photo]. Retrieved from Wikimedia Commons.
Deep DiveNew antitrust merger guidelines could have significant chilling effect on healthcare deals
Regulators have historically struggled to make a case against complex and non-traditional tie-ups. That could change with the new guidelines.
By Rebecca Pifer • July 21, 2023 -
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Prior authorization denials could limit access in Medicaid managed care, OIG reports
Medicaid managed care organizations denied one out of every eight requests for prior authorization in 2019, and most states don’t regularly monitor if denials are appropriate, the HHS’ Office of the Inspector General found.
By Emily Olsen • July 20, 2023 -
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CMS pausing Medicaid redeterminations in states noncompliant with renewal requirements
The Biden administration is cracking down on states in an effort to curb rampant procedural disenrollments from the safety-net program.
By Rebecca Pifer • July 20, 2023 -
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Colorado to shut down failing Friday Health Plans
State regulators had initially hoped the insurtech could operate for the rest of the year, but Colorado’s insurance division became concerned about Friday’s longevity after placing the insurer into rehabilitation.
By Emily Olsen • July 18, 2023 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC withdraws ‘outdated’ antitrust policy statements. Hospitals cry foul.
Hospital groups said they were deeply disappointed with the decision, which removes a guidepost for those looking to consolidate without attracting the ire of regulators.
By Rebecca Pifer • July 18, 2023
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