As the Centers for Medicare and Medicaid Services (CMS) weighs the expansion of Medicare Advantage (MA) coverage through automatic enrollment, it's worth asking if the program is meeting the needs of U.S. seniors at a responsible cost to the American taxpayer. Providers say no, and are calling for Congressional action to solve some of...
The issue brief from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) argues that technology-enabled care, including AI, telehealth, and remote patient monitoring, will only deliver value if payment models shift away from FFS and toward outcomes-aligned, value-based care.
ASPE warns that under fee-for-service...
A federal jury in Florida convicted Gary Cox, the CEO of Power Mobility Doctor Rx, for his role in operating an internet-based platform that generated false doctors’ orders to defraud Medicare and other federal healthcare benefit programs of more than $1 billion.
Gary Cox, 79, of Maricopa County faces 60 years in prison after being...
While telehealth usage among Medicare beneficiaries has declined since the pandemic peak, more than 10% of traditional Medicare enrollees used virtual care in 2023. Providers, patients, and digital health stakeholders are urging federal lawmakers to ensure continued Medicare reimbursement for telehealth before current flexibilities...
During COVID-19, rules constricting the use of telehealth were waived, opening doors for enrollees in Medicaid to receive behavioral health services through such technology. As a result, providers rapidly shifted their services to focus on telehealth availability, which may have unintended consequences for certain populations.
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This week, Senate Finance Committee Chair Ron Wyden (D-Ore.) and ranking Republican Mike Crapo (Idaho) released a white paper requesting public input on the Medicare physician payment system, signaling that reform could be included in the year-end healthcare package that is expected to include permanent telehealth expansion.
The paper...
On Wednesday, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in healthcare.
The updated rule does not force medical...
Providers, payers and the government have yet to reach a consensus on how telehealth services will be compensated following the COVID-19 pandemic and the waivers that the public health emergency allowed.
During the pandemic, Congress required that insurance companies pay equally for virtual visits as it would for in-person care for...
Walgreens pharmacists from as many as 300 locations staged a walk off this week to protest poor working conditions.
Organizers told the Associated Press that the walkouts were planned for Monday through Wednesday, but a Walgreens spokesperson said that no more than a dozen stores had experienced disruptions. Walgreens workers are not...
The Medicare Payment Advisory Commission (MedPAC) published its annual June Report to Congress, which includes suggestions to unify payment methodologies for post-acute care, address issues within Medicare Advantage, and lower telehealth payments.
The MedPAC recommendations for streamlining payment methodologies for skilled nursing...
Today is the last day of the COVID-19 public health emergency (PHE), and policies are rapidly shifting to accommodate the post-pandemic healthcare landscape in the U.S.
On Tuesday, the Drug Enforcement Administration (DEA) announced that it would continue allowances for telehealth companies to prescribe controlled substances for six...
Providers who use telehealth platforms are already concerned about the restrictions they will face if the public health emergency (PHE) ends and COVID-19-related waivers for telemedicine expire. But new rules from the Drug Enforcement Administration (DEA) will further complicate their practices.
Under the DEA's new rule, patients will...
Industry stakeholders and patient advocacy organizations are urging Congress to pass legislation that would solidify telehealth waivers passed by the CARES Act during the COVID-19 public health emergency (PHE).
The vast majority of providers see telehealth as an opportunity to improve patient services and 94% of patients who have had...
Last Friday, the U.S. House of Representatives passed the $1.7 trillion omnibus spending bill ahead of the Christmas deadline. The legislation includes big news for the healthcare sector, which responded to the bill with mixed feelings.
One major health policy provision in the package extends key Medicare telehealth flexibilities and...
A new study by West Health Institute analyzed survey responses from 7,246 American clinicians who offer telehealth to adults.
Telehealth use for senior care increased during the COVID-19 pandemic, facilitated by waivers from the Centers for Medicare and Medicaid Services (CMS). These services are well regarded for cutting costs,...
The U.S. Department of Health and Human Services (HHS) has signaled that it will delay the end of the public health emergency (PHE) related to the COVID-19 pandemic until April, quelling fears from stakeholders that not enough time was given to review Medicaid eligibility for everyone enrolled since the pandemic began.
In Arizona,...
Following last week's Pima County Superior Court decision that reinstated a 1864 outright ban on abortion in Arizona, supporters of abortion rights sued in Maricopa Superior Court to overturn the decision.
The new lawsuit, filed by a Phoenix abortion provider and the Arizona Medical Association (ArMA), is asking for an order that says...
On Tuesday, 375 health, tech and telemedical organizations sent a joint letter to leadership of the U.S. Senate requesting action on telehealth legislation prior to the expiration of the COVID-19 public health emergency (PHE). The letter requests an extension to the telehealth policies enacted at the start of the COVID-19 pandemic that...
The Centers for Medicare and Medicaid Services (CMS) are signaling that the end of the COVID-19 public health emergency (PHE) is near.
Last week, CMS published a blog post called "Creating a Roadmap for the End of the COVID-19 Public Health Emergency," to help providers prepare for the end of the waivers and flexibilities that arrived...
Medicare Advantage prior authorization reform has strong support as legislation passed through the U.S. House Ways and Means Committee last Wednesday with unanimous support.
Representative Suzan DelBene (D-Wash.), who introduced the Improving Seniors Timely Access to Care Act, said the committee vote sets the stage for a floor vote...
