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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Partners HealthCare talking merger with insurer Harvard Pilgrim

One of Massachusetts’ largest health insurers, Harvard Pilgrim, has been discussing a merger with the state’s dominant healthcare provider, Partners HealthCare, in a move that could dramatically alter the increasingly consolidated market in and around Boston.

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HHS sued over failing to release communications on family planning grants, religious freedom

HHS is the target of new lawsuits by a watchdog group for failing to respond to requests to release emails and online messages—one regarding Office of Civil Rights (OCR) officials and launching of its “Conscience and Religious Freedom Division,” the other over HHS communications with outside groups on changes to a federal grant program that provides birth control and other reproductive health services to low-income Americans.

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Upside-only ACOs will leave if forced to take on downside risk

If participants in the Medicare Shared Savings Program (MSSP) are required to move into a track which involves downside risk for their organization, they’re likely to leave the program altogether, according to the results of a survey from the National Association of Accountable Care Organizations (NAACOS).

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Moody’s: For-profit hospitals’ outlook stable but value-based care investments are needed

Moody’s Investors Service maintained its stable outlook for the for-profit hospital industry, predicting some small growth in same-facility revenues and patient volumes while margins would remain flat. Looking ahead, however, it advises facilities to pay more attention to value-based care concepts and new technologies like telemedicine and artificial intelligence.

CMS cancels announcement about rejecting lifetime limits in Medicaid

CMS was set to announce on May 1 it would deny a Medicaid waiver request from Kansas to impose a three-year lifetime limit on benefits in the program, but internal disagreements scuttled the announcement at the last minute, according to The Hill.

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$5,751 for an ice pack? Hefty bills await patients just for walking into ER

In the latest article in Vox’s series on hospital billing practices, Jessica Pell told a story that isn’t a one-off case: She went to an emergency room (ER), received a minimal amount of help and still got saddled with a massive bill.

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Uninsured rate on the rise—up 4M since 2016

Years of gains in insurance coverage since the Affordable Care Act (ACA) are beginning to reverse, according to a new report from the Commonwealth Fund which found 15.5 percent of working age adults are uninsured, an increase of about four million people since 2016.

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Molina won’t rule out return to certain ACA markets

Managed care and Affordable Care Act (ACA) exchange insurer Molina Healthcare said its first quarter profits “exceed expectations” after raising premiums for its marketplace plans by about 60 percent and isn’t ruling out returning to markets in Utah and Wisconsin, where it previously offered coverage.

Around the web

If passed, this bill would help clinician-led clinical registries explore Medicare data for research purposes. The Society of Thoracic Surgeons and American College of Cardiology both shared public support for the bipartisan legislation. 

Cardiologists and other physicians may soon need to provide much more information when ordering remote patient monitoring for Medicare patients.

Why are so many cardiovascular devices involved in Class I recalls? One possible reason could be the large number of devices hitting the market without undergoing much premarket clinical testing. 

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