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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Democrats in California at odds over push for single-payer

In Democrat-dominated California, an intraparty fight is brewing over how to remake the state’s healthcare system. In one corner, advocates are trying to achieve universal healthcare by expanding the Affordable Care Act’s gains in insurance coverage. In the other, there are diehard supporters of moving to a single-payer system.

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CMS: 11.8M enrolled on ACA exchanges but ‘more affordable options are needed’

In its final report on the 2018 open enrollment period on the Affordable Care Act (AC) exchanges, CMS said 11.8 million people selected or were re-enrolled in a plan. While the final tally combining enrollment from the federal and state exchanges represents a 3 percent decline from the prior year, supporters of the ACA painted it as a positive, considering cuts in outreach and advertising and the push to repeal the law by the Trump administration.

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High cost of billing complexity: Up to $54B in physician office revenue challenged every year

Every year, physician offices may deal with as much as $54 billion in revenue being challenged by insurers, with fee-for-service (FFS) Medicaid being “the most challenging type” of payer to bill, according to a study published in Health Affairs.

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How Iowa’s new law gets around ACA insurance requirements

Iowa Gov. Kim Reynolds signed legislation into law to allow health plans that don’t comply with Affordable Care Act regulations with a new kind of strategy: Defining some insurance plans as something other than health insurance.

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5 things to know about final Medicare Advantage, Part D rule for 2019

CMS has finalized its rule for 2019 rates for Medicare Advantage and Medicare Part D, giving insurers a bigger-than-expected rate increase while finalizing proposals on expanded supplemental benefits and efforts aimed at fighting opioid addiction.

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Doctors suing Atrium Health will be allowed to leave system

In a lawsuit aimed at allowing a physician practice to break away from the region’s dominant health system, physicians at the Mecklenburg Medical Group (MMG) have accused Charlotte’s Atrium Health of monopolistic practices that have been harmful to patients and go against its nonprofit mission. Atrium responded by saying the 92 doctors who want to leave will be allowed to do so.

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New CDC director: We can end AIDS epidemic within 7 years

In his first all-staff meeting as director of Centers for Disease Control and Prevention, Robert Redfield, MD, predicted the U.S. could end the AIDS epidemic with tools already available. He also committed the agency’s policies to be rooted in scientific evidence.

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Sutter Health sued by California for alleged anticompetitive practices

California Attorney General Xavier Becerra announced his office has filed an antitrust lawsuit against Sacramento-based Sutter Health, alleging the system used its dominance in Northern California to unlawfully raise prices for services and then used the profits reaped from these practices to grow even larger.

Around the web

With generative AI coming into its own, AI regulators must avoid relying too much on principles of risk management—and not enough on those of uncertainty management.

Cardiovascular devices are more likely to be in a Class I recall than any other device type. The FDA's approval process appears to be at least partially responsible, though the agency is working to make some serious changes. We spoke to a researcher who has been tracking these data for years to learn more. 

Updated compensation data includes good news for multiple subspecialties. The new report also examines private equity's impact on employment models and how much male cardiologists earn compared to females.

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