On Tuesday, the Department of Health and Human Services announced funding relief for providers that rely exclusively on Medicaid reimbursements following months of pleading by providers, industry professionals and politicians.
Organizations like the American Hospital Association, America’s Essential Hospitals and the American Health...Arizona News
The Navajo Reservation in northeastern Arizona received a financial boost for assistance during the COVID-19 pandemic just as rates for new cases started to decline. The Department of Health and Human Services announced that it would grant half a billion dollars to the Indian Health Service and teams from two medical organizations were...CMS Rules
The Centers for Medicare & Medicaid Services (CMS) released the final payment notice for 2021 last week as the Trump administration finalized a string of regulatory changes to Affordable Care Act (ACA) marketplace. The agency's rule outlines ACA plan regulations that impact qualified health plans (QHP) for the 2021 coverage...National News
This week the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) released the rule designed to overhaul the ways in which patients, insurers and providers interact with and exchange patient data.
The rules were part of the 21st Century Cures Act,...News
Following last year’s controversial price transparency rule mandating that hospitals disclose the rates they negotiate with insurers online for specific services, payers have decided to counter the rule with an initiative of their own.
The Centers for Medicare and Medicaid Services (CMS) revealed the list of 70 mandated...CMS Rules
Following last year’s controversial price transparency rule mandating that hospitals disclose the rates they negotiate with insurers online for specific services, payers have decided to counter the rule with an initiative of their own.
The Centers for Medicare and Medicaid Services (CMS) revealed the list of 70 mandated services...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
In back-to-back rulings, two federal judges struck down a rule by the Trump administration which allowed healthcare providers to decline patient care based on religious or moral objections to specific procedures, patient gender or patient sexual preference.
On Wednesday, Judge Paul A. Engelmayer of a United States District Court...Arizona News
Work requirements for Medicaid beneficiaries have currently been approved in nine states, including Arizona, and an estimated 76,000 to 103,000 Arizonans could lose coverage as a result. Hundreds of thousands of other beneficiaries across eight other states are also at risk of losing their coverage after 12 months of implementation,...Arizona News
Two studies highlight the role of health plans in driving up out-of-pocket prescription drug costs for 2019 individual Affordable Care Act (ACA) exchange enrollees, while insurers continue to file lawsuits against the federal government for unpaid cost-sharing reduction payments (CSRs).
Multiple insurers filed status reports in...National News
HHS released proposed rules for Medicare Advantage and Part D plans in November. On Tuesday February 26th, the Senate took testimony from seven drug company executives.
The pharmaceutical companies placed blame on the Pharmacy Benefit Management companies (PBMs) and warned that if they were to face outrageous solutions to lower...National News
Prescription drug rebates are typically negotiated by pharmacy benefits managers (PBM), such as CVS and United (two of the largest PBMs), but Department of Health and Human Services (HHS) Secretary Alex Azar says he has the power to eliminate them in the United States.
Pharmaceutical companies on Thursday, Aug. 10 were notified...National News
A federal report conducted by the Office of the Inspector General (OIG) on Tuesday revealed how some hospices take advantage of Medicare payments and in some cases, are negligent of patients.
Hospice services can play an essential role in ensuring the comfort of terminally ill patients. It is a popular Medicare benefit and...National News
Congress has shown a vested interest to start modernizing Stark Law to support the Medicare reimbursement transition to a value-based system.
In a hearing last week, U.S. House of Representatives' Ways and Means Committee Subcommittee on Health expressed their dedication to making necessary changes to update the law that prohibits...National News
Gov. of Kentucky Matt Bevin didn’t get the ruling he was hoping for in court for his Medicaid overhaul plan and now his administration is making dental and vision coverage cuts for almost 500,000 residents.
On Friday, U.S. federal judge James E. Boasberg rejected Kentucky’s proposal to enact work requirements in the Medicaid...Arizona News
The 2019 budget requests hits insurer and payer hot spots including ACA Medicare risk corridor payments and cost-sharing reductions, uncompensated care payments, Medicare post-acute care costs and even graduate medical education.
Trump’s proposal outlines his administration’s priorities – Congress makes the decisions.
Budget...National News
The 365 page rule released Friday is Notice of Benefit and Payment Parameters for 2019.
A stated goal is increasing states’ power to administer the Affordable Care Act. A focus on increased flexibility for states has been touted as the Trump administration’s approach to healthcare policy.
Significantly, states will be allowed...
