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Fewer electronic health record requirements, smaller payment reforms and changing the definition of financial risk are some of the changes suggested by major healthcare groups in response to the CMS request for information on future models at the Center for Medicare and Medicaid Innovation (CMMI).

If the Affordable Care Act’s individual mandate is repealed as part of a Republican tax cut plan, premiums will likely rise and insurers will exit the individual market, according to the American Academy of Actuaries.

Massachusetts Gov. Charlie Baker signed a law on Nov. 21 to require insurers cover birth control products without copays, allow women to obtain a year’s supply at once and prevent most employers from opting out of contraceptive coverage on moral or religious grounds.

Alex Azar, President Donald Trump’s nominee for HHS Secretary, was paid nearly $2 million in his final year as an executive at pharmaceutical giant Eli Lilly and built a portfolio worth as much as $20.6 million in his nearly 10-year tenure at the company.

Several changes to Medicare Advantage and Medicare Part D prescription drug plans have been included in a proposed rule by CMS in an effort to fight opioid abuse among seniors while taking another step towards reducing regulations.

 

Recent Headlines

Healthcare policy put to voters in Maine, Ohio on Election Day 2017

Two state ballot referendums on Nov. 7 dealt with healthcare issues, with voters in Maine approving an expansion of Medicaid eligibility while Ohio voters soundly rejected a measure to tie pharmaceutical prices paid by the state to rates paid by the U.S. Department of Veteran Affairs (VA).

CMS administrator signals big changes to Medicaid

States will have more flexibility to change their Medicaid programs, CMS Administrator Seema Verma said in a speech that criticized the Affordable Care Act (ACA)’s expansion of eligibility and called opposition to work requirements for able-bodied beneficiaries “soft bigotry” from the last administration.

More clinicians will be exempt from MIPS in 2018, won’t be able to opt in

CMS has finalized the rule for the second year of Medicare Access and CHIP Reauthorization Act’s (MACRA) Quality Payment Program (QPP), raising the low-volume threshold for the Merit-based Incentive Payment System (MIPS) but not allowing clinicians the option to participate if they don’t meet the minimum requirements.

5 things about the final OPPS rule and hospitals’ lawsuit over 340B change

CMS released its final hospital outpatient prospective payment system (OPPS) rule for 2018, which included a significant cut to drug payments to hospitals which use the 340B drug discount program. The result was the quick threat of a lawsuit from three major medical groups.

10 things Democrats want from the next HHS Secretary

The top Democrats on the Senate’s finance and health committees have outlined 51 criteria for judging President Donald Trump’s next nominee to run HHS, with many of their priorities going against the policies touted by Trump and former HHS Secretary Tom Price, MD.

CMS proposes letting states change ACA’s essential health benefits, medical loss ratio

The definition of “essential health benefits” which Affordable Care Act-compliant health plans have to cover would be up for states to decide under a rule proposed by CMS, echoing similar provisions which had been included in Republican legislative efforts to repeal and replace the ACA.

6 states could be out of CHIP funds by January

Federal funding for the Children’s Health Insurance Program (CHIP) expired at the end of September, and with no quick renewal expected from Congress, states are on their own to keep the program afloat. According to a report from the Georgetown University Center for Children and Families, six states won’t be able to do so past early January.

Trump declaration of public health emergency on opioids could impact physicians

President Donald Trump followed through on a months-old promise to declare a national public health emergency on the opioid addiction epidemic, which could increase access to addiction treatment and additional training for physicians prescribing opioids.

Judge denies request to block Trump from halting ACA insurer subsidies

A federal judge in California denied the request of 19 attorneys general to force the immediate reinstatement of the Affordable Care Act (ACA)’s cost-sharing reduction subsidies to insurers, which were cut off by President Donald Trump.

CBO: Funding ACA insurer subsidies would reduce federal deficit by $3.8B

Legislation to fund the Affordable Care Act (ACA)’s cost-sharing reduction subsidies for two years while expanding state waivers and availability of catastrophic insurance plans would preserve the current level of health insurance coverage while lowering federal spending, according to the Congressional Budget Office (CBO).

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