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Policy

 

The deal to fund the Affordable Care Act (ACA)’s halted cost-sharing reduction subsidies while expanding the state waiver process has the support of several major healthcare groups along with 10 governors and 24 senators. President Donald Trump, however, hasn’t been clear on whether he’ll support the bill as-is.

President Donald Trump is considering nominating Alex Azar, a former executive for pharmaceutical giant Eli Lilly, as the next secretary of HHS, which could place the agency in the hands of man who has been skeptical of value-based care and opposed drug price controls.

Sens. Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, have told reporters they’ve reached an agreement to fund the Affordable Care Act (ACA)’s cost-sharing reduction subsidies to insurers which had been halted by President Donald Trump.

Groups representing physicians, hospitals and patients came out largely in opposition to President Donald Trump’s executive order to encourage the use of insurance plans which don’t comply with Affordable Care Act (ACA) regulations on benefits and covering people with pre-existing conditions.

Cost-sharing reduction subsidies, or CSRs, paid to insurers in exchange for keeping out-of-pocket costs low for lower-income Affordable Care Act (ACA) exchange enrollees will end, HHS announced Thursday night, with the agency saying it couldn’t legally continue making the payments.

 

Recent Headlines

10 ICD-10 Questions Physician Senators Want CMS to Answer this Week

Concerned that the Centers for Medicare and Medicaid Services (CMS) plans for front-end testing of the ICD-10 system during the week of March 3 is too brief and too limited in scope, U.S. Senators and physicians Tom Coburn, M.D. (R-Okla.), John Barrasso, M.D. (R-Wyo.), John Boozman, O.D. (R-Ark.), and Rand Paul, M.D. (R-Ky.) have requested that the Centers for Medicare and Medicaid Services (CMS) answer their questions about the testing by February 26.

OIG to Look For Additional Kwashiorkor Fraudulent Billing in 2014

The 2014 Office of Inspector General (OIG) Workplan promises that the agency will look for more cases of hospitals miscoding malnutrition cases in Medicare patients as cases of kwashiorkor. Already this year, the agency has reached settlements with Mercy Medical Center, in Des Moines, Iowa, and Christus Saint Vincent Regional Medical Center, in Santa Fe, N.M., over incorrect billing for kwashiorkor in a combined total of 217 patients who actually did not have the disease.

5 Things the SGR Bill Does Besides Fix Doc Pay

The H.R. 4015/S. 2000, SGR Repeal and Medicare Provider Payment Modernization Act of 2014, bills also contain provisions that impact more than just physician pay. Among the provisions tucked inside the bill are these five.

CMS Resets Clock on 2-Midnight Rule

A Centers for Medicare and Medicaid Services (CMS) decision to delay the date when Recovery Audit Contractors (RACs) will start looking for inpatient claims that should have been billed as outpatient observation because of their short duration (less than a day defined as two midnights in the hospital) will buy hospitals and the groups that represent them time to fight CMS-1599-F (commonly known as the “2-Midnight Rule”).

HHS Gives Patients Direct Access to Lab Results

The U.S. Department of Health and Human Services (HHS) has amended rules covering how laboratory test results are communicated to patients to allow patients to skip going through their physician to get access to their test results.

ACA Preparedness: How to Conduct a Community Health Needs Assessment

Non-profit hospitals have to do it every three years to comply with the requirements of the federal Patient Protection and Affordable Care Act (ACA), but probably any hospital or clinic would benefit by conducting a Community Health Needs Assessment (CHNA).

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