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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Hospitals without competition have higher prices

When hospitals enjoy a monopoly in their market, their prices for privately insured patients are 12.5 percent higher on average, according to a study encompassing 88 million people covered by Aetna, Humana and UnitedHealthcare. The differences disappeared when consolidating facilities were located more than 25 miles apart.

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Japan pharma giant Takeda to buy Shire for $62B

Japan’s Takeda Pharmaceuticals has announced it will acquire Shire, an Ireland-based drug company, for $62 billion, making Takeda one of the 10 largest pharma firms in the world.

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ACA stabilization bill is dead, says Republican sponsor, as insurers propose major premium hikes

Sen. Lamar Alexander, R-Tennessee, has said he’s abandoning efforts to push a bipartisan bill meant to stabilize the Affordable Care Act (ACA) exchanges, putting the blame on Democrats’ resistance to making changes to the law. With no congressional action likely this far into an election year, exchange insurers are requesting some eye-popping hikes for 2019 premiums.

5 objectives in CMS’s rural health strategy

“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” CMS Administrator Seema Verma, MPH, said in a statement.

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Why Trump’s proposed healthcare cuts may go nowhere

President Donald Trump is looking to a rarely-utilized process called “rescission” to cut $15 billion in federal spending he already signed into law earlier this year—with much of the reductions coming from programs like the Centers for Medicare and Medicaid Innovation (CMMI) and the Children’s Health Insurance Program (CHIP).

CMS draws line on reforms by rejecting lifetime limits in Medicaid

Kansas’s proposal to impose a three-year lifetime limit on Medicaid benefits has been formally rejected by CMS, with Administrator Seema Verma, MPH, saying the agency has to ensure the program “remains a safety net for those that need it most.”

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CMS approves New Hampshire to impose Medicaid work requirements

New Hampshire will become the fourth state to impose work requirements on Medicaid beneficiaries, according to a May 7 joint statement from CMS, HHS and New Hampshire Governor Chris Sununu.

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Trump claims ACA is dead—but IRS still plans to enforce employer mandate

At last week’s campaign-style rally in Michigan, President Donald Trump claimed he’d done away with the Affordable Care Act (ACA) when the 2017 tax bill repealed the individual mandate. But folks at the Internal Revenue Service (IRS), though, would disagree. A recent report from the New York Times examines IRS's plan to send out penalty notices to more than 30,000 businesses in the U.S.

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.