Policy & Regulations

This channel includes news coverage of healthcare policy and regulations set by Congress, the states, Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), U.S. Food and Drug Administration (FDA), and medical associations and societies. 

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Trump’s Supreme Court nominee could face questions on healthcare record

Brett Kavanaugh, President Donald Trump’s pick to replace Supreme Court Justice Anthony Kennedy and a D.C. Appeals Court judge, will likely face questions on his healthcare record during confirmation hearings.

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CMS will allow participants to withdraw from new bundles in March 2019

CMS has announced participants in the Bundled Payment for Care Improvement (BPCI) Advanced model will be able to retroactively withdraw beginning in March 2019.

Trump attacks Pfizer after drug price increase

President Donald Trump lashed out at drug manufacturer Pfizer after the company raised prices for 100 drugs by an average of 9 percent, effective July 1.

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Arizona law intended to limit opioid prescriptions may hurt chronic pain patients

States are desperate to act in the national opioid epidemic, but laws limiting opioid prescriptions and doses are negatively impacting chronic pain patients and leaving doctors conflicted about care delivery, NPR reported.

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Trump administration halts ACA risk adjustment payments, potentially upending insurance markets

On July 7, CMS announced it will stop making risk adjustment payments, which were designed as part of the Affordable Care Act (ACA) to help insurers that accept more high-cost patients avoid major losses.

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CMS delays deadline for opting into bundled-payment initiative

CMS bumped back the due date for providers to opt into the Bundled Payments for Care Improvement (BPCI) Advanced model—moving the final date to Aug. 8 from Aug. 1. The move comes in amid growing concerns from those in the industry that claims data were not provided in a timely fashion.

CMS approves Oklahoma proposal for value-based Medicaid agreements with drug manufacturers

CMS has issued an approval to Oklahoma to negotiate value-based supplemental rebate agreements directly with drug manufacturers, which could produce extra rebates for state, should clinical outcomes not be achieved.

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CMS policy to reduce hospital-acquired infections has minimal impact on reimbursement

New research published in Infection Control & Hospital Epidemiology suggests the 2008 CMS’ policy, Hospital Inpatient Prospective Payment System (IPPS), which penalizes hospitals for hospital-associated conditions (HAC) present at the time of the patients’ admission to the hospital has had a minimal impact on hospital reimbursement.

Around the web

CMS finalized a significant policy change when it increased the Medicare payments hospitals receive for performing CCTA exams. What, exactly, does the update mean for cardiologists, billing specialists and other hospital employees?

Stryker, a global medtech company based out of Michigan, has kicked off 2025 with a bit of excitement. The company says Inari’s peripheral vascular portfolio is highly complementary to its own neurovascular portfolio.

RBMA President Peter Moffatt discusses declining reimbursement rates, recruiting challenges and the role of artificial intelligence in transforming the industry.