CMS to ease Medicare ACOs into risk models in bid to boost participation

Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.

By Shannon Muchmore • Nov. 2, 2022

CMS finalizes requirements for rural emergency hospital designation

The conditions of participation include maintaining an average length of stay of no more than 24 hours and having emergency care available 24 hours a day, seven days a week.

By Shannon Muchmore • Nov. 2, 2022

Explore the Trendline➔

Surprise Billing

Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.

By Healthcare Dive staff

Hospitals face lowest readmission fines since 2014, analysis finds

More than 2,200 hospitals will incur penalties, the lowest number in nearly a decade, as the CMS adjusted its calculations for the impact of the COVID-19 pandemic.

By Susan Kelly • Nov. 2, 2022

Healthcare lobbying rose 70% over past two decades

U.S. healthcare lobbying expenditures totaled almost $714 million in 2020, compared to $358 million in 2000, according to new research.

By Rebecca Pifer Parduhn • Oct. 31, 2022

Seniors to see reduced delays in Medicare coverage under new Biden admin policies

Under the changes, traditional Medicare coverage will kick in the month immediately after enrolling.

By Samantha Liss • Oct. 31, 2022

13 hospitals receive funding as special pathogen care hubs

The healthcare facilities will lead regional responses against pathogens such as COVID-19, Ebola and monkeypox.

By Susan Kelly • Oct. 26, 2022

‘I don’t feel safe.’ Abortion bans add new uncertainty to fertility treatment

State laws banning abortion could also impact people trying to conceive via in vitro fertilization and bring new legal risks for providers.

By Sydney Halleman , Delilah Alvarado , Shaun Lucas , Jasmine Ye Han • Oct. 24, 2022

DOJ requests more info on CVS, Signify deal

The second request, which CVS and Signify received on Wednesday, gives regulators another 30 days to review the proposed transaction.

By Rebecca Pifer Parduhn • Oct. 21, 2022

Molina whistleblower case moves forward after SCOTUS declines to hear challenge

A former contractor alleged the payer billed and received payment from the Illinois Medicaid program for services it did not provide.

By Hailey Mensik • Oct. 19, 2022

HHS needs to update strategic national stockpile procedures, GAO report says

Current procedures the HHS uses to make inventory decisions are hampering its ability to ensure the stockpile has the right resources in the right quantities to combat future crises, a GAO report found.

By Hailey Mensik • Oct. 18, 2022

Falling MA star ratings dog payers’ future earnings

Volatility in MA stars for the 2023 plan year is raising questions around the earnings outlooks issued by payers.

By Rebecca Pifer Parduhn • Oct. 18, 2022

Hospital price transparency ‘moving in the right direction’

A new report from Turquoise Health finds progress in compliance with federal rules created to help consumers comparison shop for medical services.

By Susan Kelly • Oct. 18, 2022

Biden admin increases funding for community mental health clinics

The HHS is awarding $15 million in new grants early next year to states developing community mental health clinics, on top of almost $300 million awarded in September.

By Rebecca Pifer Parduhn • Oct. 18, 2022

DOJ sues Cigna for exaggerating patient illnesses

The insurer paid vendors to conduct in-home visits with its members, then pressured the vendors to record high-value diagnoses that would lead to higher payments for Cigna, the DOJ alleges.

By Samantha Liss • Oct. 18, 2022

HHS approves Medicaid housing intervention program in Arizona

It’s the latest demonstration approval from the agency, following others in Oregon and Massachusetts targeted at expanding access to coverage and addressing nutrition and housing needs.

By Hailey Mensik • Oct. 17, 2022

States need help to enforce mental health parity laws, report finds

Researchers from Georgetown University advocate for more federal support to remove insurance-related obstacles to treatment.

By Susan Kelly • Oct. 17, 2022

Price transparency data provides new visibility into real rates paid to providers

Payers can use the data to gain insights regarding the rates hospitals have negotiated with other payers, which potentially can be used during contract negotiations, BRG analysts argue.

By JoAnna Younts and Konstantin Gorelik • Oct. 14, 2022

Family glitch fix for ACA premium subsidies finalized

The new rule extends premium subsidies to previously ineligible dependents of workers with employer-sponsored coverage.

By Susan Kelly • Oct. 12, 2022

Fewer MA plans with Part D earn 4 stars in latest CMS tally

Just over half of plans received four stars or more for 2023, a sharp decrease from 68% last year.

By Susan Kelly • Oct. 10, 2022

Hospitals are hiding prices from patients, advocacy report says

Patient Rights Advocate concluded that some hospitals owned by Ascension and HCA Healthcare are omitting rates for medical services from files made public under new federal rules.

By Susan Kelly • Oct. 10, 2022

Providers now required to share greater scope of patient data

As of Thursday, the amount of data that healthcare entities must share to comply with sweeping information blocking regulations has increased, despite providers saying they’re not ready for the change.

By Rebecca Pifer Parduhn • Oct. 6, 2022

SCOTUS won’t hear challenge to health worker vaccine mandate

In January, the high court upheld the CMS rule mandating that healthcare workers be vaccinated against COVID-19 at medical facilities that receive federal funding.

By Hailey Mensik • Oct. 4, 2022

Medicare Advantage premiums set to drop again next year

Enrollment in the popular plans is expected to continue to grow in 2023, CMS predicts.

By Susan Kelly • Oct. 3, 2022

Medicare Part B premium to drop for first time in a decade, Biden says

The reduction is tied to lower-than-expected spending for the controversial Alzheimer’s drug Aduhelm.

By Susan Kelly • Sept. 28, 2022

Stopgap Senate bill advances, but leaves COVID-19 funding behind

The bill cuts funding for COVID-19 and monkeypox aid but extends two rural hospital programs.

By Sydney Halleman • Sept. 28, 2022