Biden administration announces appeal to ACA preventive mandate ruling

The Justice Department on Friday appealed a Texas judge's ruling that struck down part of the ACA requiring health plans to fully cover certain preventive medical services like HIV drugs and cancer screenings.

By Hailey Mensik • April 3, 2023

CMS increases MA rate bump for 2024

Risk adjustment changes will now be phased in over three years, after payers pushed back on the proposed payment rule.

By Shannon Muchmore • April 3, 2023

Medicaid redeterminations have restarted. Here’s what we know

States began disenrolling ineligible beneficiaries from Medicaid earlier this year in an event the CMS has called the biggest health coverage transition since the first ACA open enrollment.

By Rebecca Pifer Parduhn , Sydney Halleman • March 31, 2023

CVS-Oak Street deal clears regulatory hurdle as antitrust waiting period expires

Oak Street also announced last week that it’s canceling its annual board meeting following the CVS deal, which is expected to close in the first half of the year. Oak Street stockholders will meet on April 28 to vote on the sale.

By Rebecca Pifer Parduhn • March 30, 2023

UnitedHealthcare cuts back prior authorization requirements

Provider groups applauded the move, but said they’d need to see how the requirements are rolled back before passing judgment on whether the step would ease documentation burdens on physicians.

By Rebecca Pifer Parduhn • March 30, 2023

Judge tosses ACA preventive care mandate

The Thursday ruling means that, effective immediately, health plans nationwide are no longer required to fully cover certain preventative medical services like cancer, HIV and diabetes screenings.

By Hailey Mensik • March 30, 2023

Warren calls on CMS to finalize MA payment change

Insurance and provider lobbies called on the CMS to delay the rule earlier this month, saying the methodology was flawed and arguing the 30-day comment period didn't give them enough time to analyze the proposed changes.

By Shannon Muchmore • March 29, 2023

AHIP, AHA join forces in amicus brief to SCOTUS False Claims Act case

The groups argue the expansion of the FCA would threaten the “legitimate business activities of every government contractor, hospital, healthcare provider, health insurance provider, and grant recipient in the nation.”

By Sydney Halleman • March 29, 2023

Ohio AG sues ‘modern gangsters’ Cigna, Humana for alleged PBM price fixing

Ohio Attorney General David Yost filed suit on Monday against the payers' PBMs, along with Prime Therapeutics, for allegedly sharing pricing information and driving up drug prices.

By Hailey Mensik • March 28, 2023

Oscar Health names former Aetna CEO Mark Bertolini as new chief executive

Bertolini brings decades of experience in the payer sector — including overseeing Aetna’s $70 billion sale to CVS in 2018 — to Oscar as the insurer works toward profitability.

By Rebecca Pifer Parduhn • March 28, 2023

North Carolina becomes 40th state to expand Medicaid

The expansion puts an end to a decade-plus political battle in North Carolina over Medicaid and illustrates mounting support for the program.

By Rebecca Pifer Parduhn • March 27, 2023

CVS closes $8B Signify acquisition

The combined company will work on care delivery and engagement, particularly for Medicare Advantage customers, according to an announcement.

By Rebecca Pifer Parduhn • Updated March 29, 2023

Moderna CEO defends price of COVID shot at Senate hearing

Stéphane Bancel said his company’s planned price hike covers the higher costs of commercial sales. Sen. Bernie Sanders called it part of industry’s “unprecedented level of corporate greed.”

By Christopher Newman • March 22, 2023

DOJ drops appeal against UnitedHealth’s acquisition of Change

In a Monday filing with a federal appeals court, the DOJ-led group agreed to withdraw its suit against a ruling that had allowed the merger.

By Sydney Halleman • March 22, 2023

Arbiters instructed to resume No Surprises Act determinations

The CMS had previously paused and resumed earlier disputes between payers and providers after a Texas judge ruled against the federal government and vacated portions of the law that bans surprise billing.

By Sydney Halleman • March 21, 2023

Provider directories remain inconsistent, despite No Surprises Act provisions

In a new study, researchers analyzed health plan provider directories for over 40% of U.S. physicians, and found inconsistencies for 81% of doctors across five major insurers.

By Rebecca Pifer Parduhn • March 17, 2023

The health of a community depends on fair health insurance practices

Access to local and convenient care is critical for a community’s health. However, the current approach from payers puts this at risk, argues Antonio Rios, chief of population health at Northeast Georgia Health System.

By Antonio Rios • March 17, 2023

CMS lays out plans for negotiating drug prices

The guidance fills in details for one of the central pharmaceutical provisions of the Inflation Reduction Act, signaling how the agency will use its new authority.

By Christopher Newman • March 16, 2023

Majority of states plan to take their time with Medicaid redeterminations

Some states are proposing to unwind Medicaid coverage more slowly, while others are moving more quickly to focus on reducing budgetary costs, according to a survey from the Kaiser Family Foundation.

By Rebecca Pifer Parduhn • March 16, 2023

Oscar Health names current physician leader new CMO

Sean Martin is stepping up as chief medical officer of the New York-based insurer, after Oscar’s old CMO left to become CMO of L.A. Care Health Plan in December.

By Rebecca Pifer Parduhn • March 15, 2023

Physicians say prior authorization rules harm patients, AMA survey finds, as CMS works toward new policy

Over a third of physicians said the requirements led to a serious adverse event for one of their patients, such as hospitalization, permanent impairment or death, the survey found.

By Hailey Mensik • March 14, 2023

Biden’s proposed HHS budget aims to make pandemic-era subsidies permanent

The budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices.

By Sydney Halleman • March 9, 2023

House committee latest to launch investigation into PBMs

It’s the most recent action targeting PBMs for allegedly using their market power to raise drug prices, and comes as the Federal Trade Commission also launched a similar investigation.

By Hailey Mensik • March 8, 2023

Insurers, trade groups ask CMS to delay MA rule

Insurance lobbyists argue that the 1.03% plan increase is insufficient and, in combination with other changes, would actually result in payment cuts.

By Sydney Halleman • March 7, 2023

FTC pushes back deadline for public to weigh in on noncompete ban

FTC Commissioner Christine Wilson said she would have supported an even longer extension since the proposed rule is “a departure from hundreds of years of precedent.” 

By Samantha Liss • March 7, 2023