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If the Affordable Care Act’s individual mandate is repealed as part of a Republican tax cut plan, premiums will likely rise and insurers will exit the individual market, according to the American Academy of Actuaries.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

Rep. Blumenauer tries once more for Medicare benefit expansion into hospital-to-home transition services

House Rep. Earl Blumenauer (D-Ore) re-introduced his bipartisan Medicare Transitional Care Act in the 113th Congress on Thursday. The bill seeks to create a new benefit to support and coordinate care for Medicare beneficiaries as they move from the hospital setting to their homes or other care setting.

Register now to check accuracy of industry payments CMS will attribute to you under Sunshine Act

Physicians and teaching hospitals that want the chance to review information about payments or other transfers of value they’ve received from pharmaceutical, medical device and other industry groups before this information is made public should register with the Centers for Medicare and Medicaid Services (CMS) starting Sunday, June 1, 2014.

Court ruling ends some hospitals’ discount on orphan drugs

Rudolph Contreras, judge for the U.S. District Court for the District of Columbia, has ruled the U.S. Department of Health and Human Services acted outside of its regulatory authority when it interpreted the law covering payments for pharmaceuticals with “orphan drug” status as not applying to payments when the drug was prescribed for a condition for which it was not an “orphan drug,” such as Prozac prescribed for depression (its most common use) instead of either of Prozac’s two orphan indications.

Journalists sue HHS for access to Medicare Advantage data

Last year, the U.S. Department of Health and Human Services (HHS) made Medicare hospital payment data public, followed this year by individual physician payment data. Now journalists want data on the private Medicare Advantage plans and have filed suit to get it.

AHA and three hospitals sue Sebelius over appeals backlog

The backlog of appeals of recovery audit contractor (RAC) decisions “has reached a crisis point” says the American Hospital Association (AHA) and three hospitals who have brought suit against outgoing U.S. Department of Health and Human Services Secretary Kathleen Sebelius over the length of time it now takes to have an appeal of a reimbursement claim denial decided by an adiminstrative law judge.

Ways and Means hearing focuses on controversial 2-midnight rule

Tuesday’s House Committee on Ways and Means Subcommittee on Health hearing on current hospital issues in the Medicare program demonstrated that there is broad agreement that last year’s “2-midnight rule” for determining hospital inpatient status in a more standardized way is not working as intended.

Union drops controversial ballot initiatives in exchange for concessions from California Hospital Association

The Service Employees International Union-United Healthcare Workers West (SEIU-UHW) has dropped its campaign for voter-passed laws that would have limited what California hospitals could charge their patients and what they could pay their executives. In return, the SEIU-UHW got the California Hospital Association (CHA) and its member hospitals to agree to a code of conduct that should make it easier for the union to organize hospital workers.

CMS cuts red tape to save providers millions

The Centers for Medicare & Medicaid Services (CMS), has issued a set of final regulatory changes that it says will save healthcare providers nearly $660 million annually, and $3.2 billion over five years.

AHA members bring long list of issues to the Hill

American Hospital Association (AHA) members and leaders were in Washington, D.C., this week for the AHA Annual Membership Meeting and lobbied their members of Congress on many of the top issues outlined in the association’s 91-page-long 2014 Advocacy Agenda.

2015 inpatient PPS rates rule also expands price transparency

The Centers for Medicare and Medicaid Services has issued its hospital inpatient prospective payment system (PPS) and long-term care hospital PPS proposed rule for fiscal year 2015, and included in the rule is a requirement that hospitals begin publically posting what they charge for services by October 1.

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