Government: Page 86
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AHA files another challenge to CMS site neutral payment policy
The same court ruled in favor of hospitals in September, but later determined it could not keep CMS from attempting the policy again for 2020.
By Shannon Muchmore • Jan. 14, 2020 -
Dignity Health loses appeal of Medicaid out-of-network billing case
The hospital operator said it may try to take the case against L.A. Care, the largest public Medicaid managed care plan in the country, to the California Supreme Court.
By Ron Shinkman • Jan. 13, 2020 -
Trendline
Labor
Hospitals are navigating persistent labor shortages with the need to cut costs — a source of contention that could leave patients caught in the middle.
By Healthcare Dive staff -
Supreme Court to take on PBM rate regulation
A federal appeals court previously ruled in favor of pharmacy benefit managers, finding federal law preempts states from regulating their rates.
By Samantha Liss • Jan. 13, 2020 -
A biotech startup launches with unusual goal: invent new drugs, and sell them for less
Founded by venture capitalist Alexis Borisy, EQRx will launch with $200 million in funding to prove out a vision as daunting as it is ambitious.
By Ned Pagliarulo • Jan. 13, 2020 -
The government recovered $3B in fraud last year. Nearly 90% was from healthcare
It marks the 10th consecutive year the DOJ has recouped more than $2 billion from False Claims Act settlements and judgments for HHS.
By Rebecca Pifer • Jan. 10, 2020 -
Kansas to become 37th state to expand Medicaid under ACA
Kansas joins a flurry of Republican-leaning states that have either expanded the program through their legislatures or via voter initiative, including Utah, Idaho and Nebraska.
By Ron Shinkman • Jan. 10, 2020 -
US cancer death rate drops by most on record
Reductions in smoking and earlier cancer detection have driven death rates lower, but newer treatments could be playing a larger role, too.
By Ned Pagliarulo • Jan. 9, 2020 -
Kaiser, major union launching nonprofit to boost California workforce
The $130 million organization, called Futuro Health, has a goal of graduating 10,000 new licensed and credentialed workers for the state in the next four years.
By Shannon Muchmore • Jan. 9, 2020 -
Social risk factors may influence CMS star ratings, study suggests
Providers have disputed the methodology CMS uses to compile its star ratings for years, saying the approach is overly simplistic and the presentation of data to consumers is difficult to interpret.
By Linda Wilson • Jan. 9, 2020 -
Individual market appears stable despite lack of mandate penalty
Claims costs in the first nine months of 2019 grew and average hospital time dipped, indicating the market didn't have disproportionately sicker patients, according to the Kaiser Family Foundation.
By Shannon Muchmore • Jan. 8, 2020 -
CMS proposes using more encounter data for MA risk adjustment
The mix of encounter data used to calculate payments would go up to 75% next year under the proposed regulation. Payers have railed against previous increases, saying the information is inaccurate and unreliable.
By Shannon Muchmore • Jan. 7, 2020 -
Ex-Anthem exec Brad Smith appointed head of CMS innovation center
Smith, previously co-founder and CEO of palliative care company Aspire Health, replaces outgoing CMMI head Adam Boehler.
By Rebecca Pifer • Jan. 7, 2020 -
Beyond the ACA: Healthcare legal fights to watch in 2020
Payers and providers are contesting a price transparency push. The Trump administration is also being challenged over risk corridor payments and the expansion of association health plans.
By Shannon Muchmore , Samantha Liss • Jan. 6, 2020 -
Alex Wong via Getty Images
Providers embrace loosening Stark Law regulations, suggest feds could go further
The Trump administration's proposed relaxation of regulations around the law has nearly unanimous support in both the hospital and physician community, most of whom say they are chafing against the requirements.
By Ron Shinkman • Jan. 6, 2020 -
Pfizer, AbbVie and Gilead among drugmakers boosting prices to start 2020
List prices rose on some of the top-selling medicines in the U.S., including Humira, Opdivo, Prevnar 13 and Biktarvy.
By Andrew Dunn • Jan. 2, 2020 -
Permission granted by Geisinger Health
Despite provider claims, hospital M&A not associated with improved care, NEJM finds
The findings refute a common provider justification for rampant M&A, but the American Hospital Association pushed back on researchers' reliance on patient surveys.
By Rebecca Pifer • Jan. 2, 2020 -
Getty / Edited by Healthcare Dive
Tenet deal to sell Memphis properties raises hackles of other area providers
One health system said it is "reasonably certain the FTC will be reviewing this proposed transaction given the potential negative impact it could have on the consumers in Memphis."
By Ron Shinkman • Dec. 30, 2019 -
Utah Medicaid expansion, with controversial work rules, gets nod
CMS did not approve other elements of the state's request, including charging premiums to adults with incomes above 100% of the federal poverty level and locking people out for violations.
By Linda Wilson • Dec. 24, 2019 -
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 -
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
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