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If the Affordable Care Act’s individual mandate is repealed as part of a Republican tax cut plan, premiums will likely rise and insurers will exit the individual market, according to the American Academy of Actuaries.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

HHS provides nearly $200 million to hospitals, states to deal with Ebola virus

Hospitals and states will receive nearly $200 million in funds from the Department of Health and Human Services to prepare for and respond to the Ebola epidemic.

CMS proposes decreasing payments to Medicare Advantage plans

CMS is proposing to decrease payments per beneficiary to Medicare Advantage organizations in 2016 by an average of 0.95 percent.

Special enrollment period for health insurance marketplaces

The Centers for Medicare & Medicaid Services announced on Friday a second enrollment period for people to purchase insurance coverage through the health insurance marketplaces.

President Obama: Affordable Care Act is working better than anticipated

More than 11 million people have purchased coverage on the health insurance exchanges for 2015, according to preliminary figures released in a video the White House posted on Facebook on Tuesday.

Supreme Court case could lead to a large decrease in hospital revenue

If the Supreme Court rules in favor of the plaintiff in the upcoming King v. Burwell case, hospital spending would decrease by at least an estimated $6.3 billion, according to an Urban Institute report.

Congress urges HHS to update HIPAA mHealth guidance

The Department of Health and Human Services is long overdue to update its HIPAA guidance to better regulate the rapidly evolving mobile health industry market, according to two House representatives.

CMS schedules three testing weeks for ICD-10

The Centers for Medicare and Medicaid Services has announced that it will hold three separate testing weeks to allow trading partners (including physician practices, hospitals and other healthcare providers) the opportunity to try out submitting claims using International Classification of Diseases, 10th Revision (ICD-10) codes.

AHA seeks changes in House bill to reduce fraud, waste and abuse in Medicare

The American Hospital Association (AHA) this week submitted comments to the U.S. House Committee on Ways and Means, Subcommittee on Health about the Protecting the Integrity of Medicare Act (PIMA), a bill that seeks to save the government money by making it harder to successfully defraud the system.

Pharma pushes back against CMS implication that industry is behind problems with Open Payments system

As issues continue with the Centers for Medicare and Medicaid Services (CMS) system for collecting data on industry payments to physicians and making a physician-verified version of that data available to the public by September 30, the Pharmaceutical Research and Manufacturers of America (PhRMA) industry group says don’t blame industry for data problems.

Beneficiaries now also suing about long wait for Medicare appeals hearings

Earlier this year, the American Hospital Association (AHA) and three hospital and healthcare systems sued the U.S. Department of Health and Human Services (HHS) over the long backlog in Medicare claim denial appeals. Now patients are joining in with a nationwide class action suit.

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