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Policy

 

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If the Affordable Care Act’s individual mandate is repealed as part of a Republican tax cut plan, premiums will likely rise and insurers will exit the individual market, according to the American Academy of Actuaries.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

AMA, other orgs call for rejection of Aetna/Humana merger

The American Medical Association (AMA) has joined forces with the Florida Medical Association and Florida Osteopathic Medical Association, and written a letter to Florida Attorney General Pam Bondi, calling on her to reject the proposed merger of Aetna and Humana. 

 

Proposed ACO benchmarks may penalize the orgs serving the sickest patients

An analysis from Harvard’s department of healthcare policy shows such wide variation in baseline spending levels from one ACO to the next that any future benchmarking efforts, including those performed within single given regions, must roll out parity measures only gradually—or pay the price in the form of participation falloffs.  

White House-backed bill to help states track banned providers passes House

The Ensuring Removal of Terminated Providers from Medicaid and CHIP Act (HR 3716), which helps states identify healthcare providers who have been banned from Medicare, a Medicaid program, or the Children’s Health Insurance Program, has been unanimously approved by the U.S. House.

More patients going to the doctor in wake of Medicaid expansion

A new analysis from the ACAView project, the joint effort between the Robert Wood Johnson Foundation and athenahealth to track the impact of the Affordable Care Act, has found a big bounce in primary-care visits in states that expanded Medicaid.

Federal appeals court: Hospitals can be both ‘urban’ and ‘rural’

Earlier this month, the 2nd U.S. Circuit Court of Appeals declared that the HHS “reclassification rule” was invalid and hospitals could be considered “rural” in some circumstances and “urban” in others. 

What’s on TV? Ads for expensive drugs to fight rare conditions

Americans who watch at least a few hours of TV each week are used to getting urged to ask their doctors about all sorts of medications that, chances are, they really don’t need.  

CMS publishes final rule on overpayments for Medicare Parts A and B

CMS has published a final rule that requires healthcare providers and suppliers receiving funds from Medicare Part A and Part B to report and return overpayments within 60 days of first identifying them. 

Burwell has faith remaining states will embrace Medicaid expansion

HHS Secretary Sylvia Mathews Burwell spoke to reporters last week about the Affordable Care Act’s 2016 open enrollment figures and the future of healthcare in the U.S. 

Longer hours show no significant impact on resident satisfaction or patient care

Surgical residents who are allowed to work longer hours than currently allowed so that they can stay with or stabilize patients do not show any signs of putting their patients at risk, according to a recent study published by the New England Journal of Medicine

Examination of private insurance claims data offers new insights

A recent report examining employer-sponsored private insurance claims data found that basing healthcare decisions on Medicare data might not be the best practice. The researchers found that the correlation between total spending per Medicare beneficiary and total spending per privately insured beneficiary was 0.14 in 2011, while the correlation for inpatient spending was 0.267.

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